title: Sensitivity of endoscopic ultrasound, multidetector computed tomography, and magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a tertiary center experience.
abstract: OBJECTIVE
  There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: (1) evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), and multidetector computed tomography (MDCT) for pancreas divisum; and (2) assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP.
  
  
  METHODS
  For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent endoscopic retrograde pancreatography and cross-sectional imaging.
  
  
  RESULTS
  The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than the sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) (P < 0.001 for each). On review by expert radiologists, the sensitivity of MDCT increased to 83.3% in cases where the pancreatic duct was visualized, with fair IOA (κ = 0.34). Expert review of MRCPs did not identify any additional cases of pancreas divisum; IOA was moderate (κ = 0.43).
  
  
  CONCLUSIONS
  Endoscopic ultrasound is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Washington University, St Louis, MO 63110, USA.
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Wani
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fowler
authors.forename: Christine
authors.initials: C
authors.lastname: Menias
authors.forename: Rakesh
authors.initials: R
authors.lastname: Varma
authors.forename: Vamsi
authors.initials: V
authors.lastname: Narra
authors.forename: Christine
authors.initials: C
authors.lastname: Hovis
authors.forename: Faris M
authors.initials: FM
authors.lastname: Murad
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Mullady
authors.forename: Sreenivasa S
authors.initials: SS
authors.lastname: Jonnalagadda
authors.forename: Dayna S
authors.initials: DS
authors.lastname: Early
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.forename: Riad R
authors.initials: RR
authors.lastname: Azar
mesh_terms: D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D010179:Pancreas / Q000002:abnormalities / Q000000981:diagnostic imaging*; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers