title: Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux.
abstract: We propose the hypothesis that the enlargement of the common bile duct (CBD) or gallbladder (GB) that is occasionally demonstrated on magnetic resonance cholangiopancreatography (MRCP) after secretin stimulation is caused by pancreatobiliary reflux. Recently, occult pancreatobiliary reflux (OPR) has been demonstrated in patients without morphological pancreatobiliary maljunction (MPBM). The aim of this study was to evaluate the efficacy of secretin-stimulating MRCP (SMRCP) in the diagnosis of pancreatobiliary reflux. The study included 14 patients with MPBM and 32 patients with a normal pancreatobiliary junction. OPR was evaluated by bile collection and diagnosed in seven of the 32 patients. All the patients underwent SMRCP; the related findings were considered positive when enlargement of the CBD or GB was observed. Positive findings on SMRCP were observed in all MPBM patients. In the patients with normal pancreatobiliary junction, there was significant difference between the mean amylase levels in the patients with positive and negative SMRCP findings (mean, 4,755.7 and 29.7 IU/l). The sensitivity and specificity of SMRCP for diagnosing OPR was 85.7% and 68.0%, respectively. SMRCP provides a non invasive method for excluding PBR and can identify patients who could benefit from bile duct sampling to diagnose OPR.
authors: Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan. utaroh-motosugi@nifty.com
authors: Utaroh
authors: U
authors: Motosugi
authors: Tomoaki
authors: T
authors: Ichikawa
authors: Tsutomu
authors: T
authors: Araki
authors: Fumiaki
authors: F
authors: Kitahara
authors: Tadashi
authors: T
authors: Sato
authors: Jun
authors: J
authors: Itakura
authors: Hideki
authors: H
authors: Fujii
mesh_terms: D000681:Amylases / Q000032:analysis; D001652:Bile Ducts / Q000473:pathology*; D001655:Bile Reflux / Q000175:diagnosis* / Q000503:physiopathology; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000503:physiopathology; D010183:Pancreatic Ducts / Q000473:pathology*; D011446:Prospective Studies; D012633:Secretin; D012680:Sensitivity and Specificity
chemical_list: D012633:Secretin; D000681:Amylases