Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP.
OBJECTIVE
To obtain reference values for pancreatic flow output rate (PFR) and peak time (PT) in healthy volunteers and chronic pancreatitis (CP); to correlate quantification of secretin enhanced magnetic resonance cholangiopancreatography (SMRCP) of pancreatic fluid output following secretin with fecal elastase-1 (FE-1) tests.


METHODS
The present study includes 53 subjects comprised of 17 healthy individuals and 36 patients with CP from April 2011 to January 2013. The 36 patients with CP were divided into three groups of mild CP (n = 14), moderate CP (n = 19) and advanced CP (n = 3) by M-ANNHEIM classification for CP.. Fifty-three cases underwent FE-1 test and magnetic resonance imaging using 3.0 T-device (Signa EXCITE, GE Healthcare). Coronal T2-weighted single-shot turbo spin-echo, spiratory triggered, covering the papillae, duodenum and small bowel. MRCP was performed with a heavily T2-weighted fat-suppressed long TE HASTE sequence (thick slab 2D MRCP sequence), repeated every 2 min up to 11 min after 0.1 mL/kg secretin injection (Secrelux, Sanochemia(®), Germany). FE-1 test used sandwich enzyme-linked immunosorbent assay (ELISA) test (ScheBo. Tech(®), Germany).


RESULTS
A good linear correlation showed between the calculated volume and the actual volume by Phantom experiments. Fifty-three paired Quantification of secretin enhanced magnetic resonance cholangiopancreatography (MRCPQ) and FE-1 data sets were analyzed. The mean FE-1 of 53 cases was 525.41 ± 94.44 μg/g for 17 healthy volunteers, 464.95 ± 136.13 μg/g for mild CP, 301.55 ± 181.55 μg/g for moderate CP, 229.30 ± 146.60 μg/g for advanced CP. Also, there was statistically significant difference in FE-1 (P = 0.0001) between health and CP. The mean values of PFR and PT were 8.18 ± 1.11 mL/min, 5.76 ± 1.71 min for normal; 7.27 ± 2.04 mL/min, 7.71 ± 2.55 min for mild CP; 4.98 ± 2.57 mL/min, 9.10 ± 3.00 min for moderate CP; 4.13 ± 1.83 mL/min, 12.33 ± 1.55 min for advanced CP. Further, statistically significant difference in PFR (P = 0.0001) and PT (P = 0.0001) was observed between health and CP. Besides, there was correlation (r = 0.79) and consistency (K = 0.6) between MRCPQ and ELISA Test. It was related between M-ANNHEIM classification and PFR (r = 0.55), FE-1 (r = 0.57).


CONCLUSIONS
SMRCP can provide a safe, non-invasive and efficient method to evaluate the exocrine function of the pancreas.
Yun Bian, Li Wang, Chao Chen, Jian-Ping Lu, Jia-Bao Fan, Shi-Yue Chen, Bing-Hui Zhao, Department of Radiology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China.
Yun
Y
Bian
Li
L
Wang
Chao
C
Chen
Jian-Ping
JP
Lu
Jia-Bao
JB
Fan
Shi-Yue
SY
Chen
Bing-Hui
BH
Zhao
D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers / Q000032:analysis; D016022:Case-Control Studies; D049448:Cholangiopancreatography, Magnetic Resonance / Q000295:instrumentation; D004796:Clinical Enzyme Tests; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000201:enzymology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000378:metabolism*; D010196:Pancreatic Elastase / Q000032:analysis*; D010186:Pancreatic Function Tests; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000378:metabolism; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D012633:Secretin; D012720:Severity of Illness Index; D055815:Young Adult
D015415:Biomarkers; D012633:Secretin; D010196:Pancreatic Elastase
Chronic pancreatitis; Magnetic resonance cholangiopancreatography; Magnetic resonance imaging; Pancreatic exocrine function; Secretin