Pancreatic ductal abnormalities documented by secretin-enhanced MRCP in asymptomatic subjects with chronic pancreatic hyperenzymemia.
OBJECTIVE
Persistently high serum pancreatic enzymes in asymptomatic subjects are considered a benign idiopathic condition called "non-pathological chronic pancreatic hyperenzymemia" (CPH). However, recent studies with advanced imaging techniques have brought to light abnormal pancreatic findings in a significant proportion of these subjects. The objective of this study was to evaluate pancreatic ductal morphology by secretin-enhanced magnetic resonance cholangiopancreatography (MRCP-S) in subjects with CPH and compare MRCP imaging before and after secretin injection.


METHODS
In total, 25 consecutive patients with CPH were investigated by MRCP and MRCP-S and compared with 28 consecutive age-matched controls with recurrent upper abdominal pain and normal pancreatic enzymemia.


RESULTS
MRCP-S showed abnormal pancreatic morphological findings in 13 of the 25 CPH cases (52%) and 1/28 controls (3.6%) (P<0.001). MRCP findings consistent with a diagnosis of chronic pancreatitis, according to the Cambridge classification, were detected in eight CPH cases (32%) after secretin injection but none of the controls. Secretin stimulation boosted the diagnostic yield of MRCP for the diagnosis of chronic pancreatitis fourfold. Pancreas divisum was identified in two CPH cases and one control. A 15-min persisting dilation of the main pancreatic duct was noted in three cases in each group. Compared with MRCP, MRCP-S showed significantly fewer CPH patients with normal findings (P<0.02).


CONCLUSIONS
MRCP-S detected ductal findings consistent with chronic pancreatitis in one-third of CPH cases. Pancreas divisum and some dysfunction at the level of Vater's papilla were reported in 8 and 12% of the patients, respectively. MRCP-S is to be recommended, instead of MRCP, in the diagnostic work-up of CPH subjects.
Division of Gastroenterology and Gastrointestinal Endoscopy, Università Vita-Salute San Raffaele, IRCCS San Raffaele Hospital, Milan, Italy. testoni.pieralberto@hsr.it
Pier Alberto
PA
Testoni
A
A
Mariani
S
S
Curioni
A
A
Giussani
E
E
Masci
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood / Q000378:metabolism*; D016022:Case-Control Studies; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000473:pathology; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000201:enzymology*; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D012016:Reference Values; D018570:Risk Assessment; D012633:Secretin; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D012633:Secretin; D000681:Amylases