Serial contrast-enhanced MRI of the pancreas: correlation with secretin-stimulated endoscopic pancreatic function test.
OBJECTIVE
The purpose of this study was to determine the relationship between the pancreatic enhancement on serial contrast-enhanced MRI (CEMRI) and pancreatic exocrine function using the secretin-stimulated endoscopic pancreatic function test (ePFT).


METHODS
A total of 30 patients with clinical symptoms consistent with chronic pancreatitis underwent CEMRI of the abdomen and ePFT within a 1- to 4-week interval. CEMRI was performed in arterial, early venous, and late venous phases. Secretin ePFT was performed with the measurement of HCO(3) concentration from the duodenal aspirates after secretin stimulation. Contrast enhancement ratio of the arterial phase to early venous phase was measured on CEMRI (SIRa/SIRv). A three-point evaluation system was used for grading the HCO(3) concentration and the enhancement ratio on MRI. For the significance of correlation, kappa statistics was used. Sensitivity and specificity of CEMRI was determined for the diagnosis of early chronic pancreatitis accepting ePFT as a reference.


RESULTS
Twenty patients had identical scores on both secretin ePFT and CEMRI. Ten patients revealed discrepancy in scores. Kappa statistics revealed moderate agreement between MRI and ePFT (kappa = 0.44). Sensitivity and specificity values for the diagnosis of pancreatitis were 82% and 57%, respectively. Positive predictive value was 56%, and negative predictive value was 86%.


CONCLUSIONS
The results of our data indicate that serial CEMRI is an appropriate imaging technique to rule out early chronic pancreatitis. However, secretin-stimulated imaging or ePFT may still be needed for the definite diagnosis of pancreatic exocrine dysfunction.
Balci
N Cem
NC
Department of Radiology, Saint Louis University, St. Louis, MO; and Giessen-Marburg University Giessen, Germany. nbalci@slu.edu
Alkaade
Samer
S
Akduman
Isin E
IE
Bilgin
Mehmet
M
Murdock
Christopher P
CP
Burton
Frank R
FR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001185:Artificial Intelligence; D003287:Contrast Media / Q000008:administration & dosage*; D004386:Duodenum / Q000187:drug effects / Q000378:metabolism; D016145:Endoscopy, Digestive System; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D005765:Gastrointestinal Agents / Q000378:metabolism*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D012189:Retrospective Studies; D012633:Secretin / Q000378:metabolism*; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005765:Gastrointestinal Agents; D012633:Secretin; D019786:Gadolinium DTPA