Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency?: A comparison with noninvasive exocrine pancreatic function tests.
BACKGROUND
Data on magnetic resonance cholangiopancreatography with secretin stimulation (S-MRCP) for the assessment of exocrine pancreatic insufficiency (EPI) are limited. We compared pancreatic function tests with the findings of S-MRCP in patients with chronic pancreatitis (CP) and disease controls.


METHODS
S-MRCP was performed in 23 patients (18 CP, 5 disease controls). MRCP images were analyzed for secretin-induced duodenal liquid filling (0=no filling; 1=duodenal bulb; 2=up to lower flexure; 3=beyond lower flexure). EPI was evaluated by fecal elastase, fecal fat concentration, and a 13C mixed chain triglyceride breath test. Clinically relevant EPI was stated if 2 of 3 tests were pathologic.


RESULTS
EPI was diagnosed in 10 of 18 patients with CP. Patients without EPI showed either grade 2 (n=4) or grade 3 (n=9) duodenal filling, whereas only 1/10 patients with EPI showed grade 3 duodenal filling. Sensitivity and specificity of S-MRCP for the diagnosis of EPI were 69% and 90%, respectively.


CONCLUSIONS
Assessment of duodenal filling should be performed in patients who undergo S-MRCP for the evaluation of pancreatic morphology. However, minor degrees of duodenal filling are equivocal and require further diagnostic evaluation.
Schneider
Arne R J
AR
Medical Department I-ZAFES, Johann Wolfgang Goethe-University Frankfurt am Main, Germany. arne.schneider@em.uni-frankfurt.de
Hammerstingl
Renate
R
Heller
Matthias
M
Povse
Nada
N
Murzynski
Lydia
L
Vogl
Thomas J
TJ
Caspary
Wolfgang F
WF
Stein
Juergen
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D049448:Cholangiopancreatography, Magnetic Resonance; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005765:Gastrointestinal Agents; D006801:Humans; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D012633:Secretin
D005765:Gastrointestinal Agents; D012633:Secretin