title: Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts.
abstract: OBJECTIVE
  We investigated the incremental diagnostic yield of S-MRCP in a population with high prevalence of small pancreatic cysts.
  
  
  METHODS
  Standard MRCP protocol was performed with and without secretin using 1.5 T units in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter Cancer of the Pancreas Screening-3 trial (CAPS 3). All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses.
  
  
  RESULTS
  Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128=4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p=0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p<0.0005).
  
  
  CONCLUSIONS
  At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions.
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Neda
authors.initials: N
authors.lastname: Rastegar
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Luciana G
authors.initials: LG
authors.lastname: Matteoni-Athayde
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: John
authors.initials: J
authors.lastname: Eng
authors.affiliation: Mayo Clinic, United States.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: MD Anderson Cancer Center, United States.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Tamm
authors.affiliation: Beth Israel Deaconess Medical Center, United States.
authors.forename: Koenraad J
authors.initials: KJ
authors.lastname: Mortele
authors.affiliation: Dana Farber Cancer Institute, United States.
authors.forename: Sapna
authors.initials: S
authors.lastname: Syngal
authors.affiliation: University of California, Los Angeles, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Margolis
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lennon
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Ralph H
authors.initials: RH
authors.lastname: Hruban
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Goggins
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States.
authors.forename: Marcia I
authors.initials: MI
authors.lastname: Canto
authors.affiliation: Departments of Medicine (Gastroenterology) and Radiology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, United States. Electronic address: ikamel@jhmi.edu.
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010181:Pancreatic Cyst / Q000473:pathology*; D010183:Pancreatic Ducts / Q000473:pathology*; D015995:Prevalence; D012633:Secretin
chemical_list: D012633:Secretin
keywords: Cyst; Magnetic resonance imaging; Neoplasm; Pancreas; Screening; Secretin