The Value of Secretin-Enhanced MRCP in Patients With Recurrent Acute Pancreatitis.
OBJECTIVE
The purpose of this study is to assess the additional value of secretin-enhanced MRCP over conventional (non-secretin-enhanced) MRCP in diagnosing disease in patients with recurrent acute pancreatitis.


METHODS
A retrospective review of a radiology database found 72 patients with recurrent acute pancreatitis who had secretin-enhanced MRCP and ERCP correlation within 3 months of each other between January 2007 and December 2011. Of these patients, 54 had no history of pancreatic tumor or surgery and underwent MRI more than 3 months after an episode of acute pancreatitis. In addition, 57 age- and sex-matched control subjects with secretin-enhanced MRCP and ERCP correlation and without a diagnosis of recurrent acute pancreatitis or chronic pancreatitis were enrolled as the control group. All studies were anonymized, and secretin-enhanced MRCP images (image set A) were separated from conventional 2D and 3D MRCP and T2-weighted images (image set B). Image sets A and B for each patient were assigned different and randomized case numbers. Two blinded reviewers independently assessed both image sets for ductal abnormalities and group A image sets for exocrine response to secretin.


RESULTS
There were statistically significantly more patients with recurrent acute pancreatitis with reduced exocrine function compared with patients in the control group (32% vs 9%; p < 0.01) on secretin-enhanced images. Patients with recurrent acute pancreatitis were more likely to have side branch dilation (p = 0.02; odds ratio, 3.6), but not divisum, compared with the control group. Secretin-enhanced images were superior to non-secretin-enhanced images for detecting ductal abnormalities in patients with recurrent acute pancreatitis, with higher sensitivity (76% vs 56%; p = 0.01) and AUC values (0.983 vs 0.760; p < 0.01).


CONCLUSIONS
Up to one-third of patients with recurrent acute pancreatitis showed exocrine functional abnormalities. Secretin-enhanced MRCP had a significantly higher yield for ductal abnormalities than did conventional MRI and should be part of the MRCP protocol for investigation of patients with recurrent acute pancreatitis.
1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202.
Kumar
K
Sandrasegaran
1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202.
Bilal
B
Tahir
2 Department of Radiology, Richard L. Roudebush VA Medical Center, Indianapolis, IN.
Udaykamal
U
Barad
3 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Evan
E
Fogel
1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202.
Fatih
F
Akisik
1 Department of Radiology, Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN 46202.
Temel
T
Tirkes
3 Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.
Stuart
S
Sherman
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007196:Indiana / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D012633:Secretin; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D055815:Young Adult
D003287:Contrast Media; D012633:Secretin
MRCP; pancreatitis; secretin