Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis.
OBJECTIVE
Chronic pancreatitis (CP) is characterized by abnormal pancreatic morphology and impaired endocrine and exocrine function. However, little is known about the relationship between pancreatic morphology and function, and also the association with the etiology and clinical manifestations of CP. The aim was to explore pancreatic morphology and function with advanced MRI in patients with CP and healthy controls (HC) METHODS: Eighty-two patients with CP and 22 HC were enrolled in the study. Morphological imaging parameters included pancreatic main duct diameter, gland volume, fat signal fraction and apparent diffusion coefficient (ADC) values. Functional secretin-stimulated MRI (s-MRI) parameters included pancreatic secretion (bowel fluid volume) and changes in pancreatic ADC value before and after secretin stimulation. Patients were classified according to the modified Cambridge and M-ANNHEIM classification system and fecal elastase was collected.


RESULTS
All imaging parameters differentiated CP patients from HC; however, correlations between morphological and functional parameters in CP were weak. Patients with alcoholic and non-alcoholic etiology had comparable s-MRI findings. Fecal elastase was positively correlated to pancreatic gland volume (r = 0.68, P = 0.0016) and negatively correlated to Cambridge classification (r = -0.35, P < 0.001). Additionally, gland volume was negatively correlated to the duration of CP (r = -0.39, P < 0.001) and baseline ADC (r = -0.35, P = 0.027). When stratified by clinical stage (M-ANNHEIM), the pancreatic gland volume was significantly decreased in the severe stages of CP (P = 0.001).


CONCLUSIONS
S-MRI provides detailed information about pancreatic morphology and function and represents a promising non-invasive imaging method to characterize pancreatic pathophysiology and may enable monitoring of disease progression in patients with CP.
Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
Adnan
A
Madzak
Centre for Pancreatic Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Søren Schou
SS
Olesen
Department of Radiology, Haukeland University Hospital, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Ingfrid Salvesen
IS
Haldorsen
Centre for Pancreatic Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Asbjørn Mohr
AM
Drewes
Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: jebf@rn.dk.
Jens Brøndum
JB
Frøkjær
D000368:Aged; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010196:Pancreatic Elastase / Q000032:analysis / Q000737:chemistry / Q000378:metabolism; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging* / Q000473:pathology*; D012633:Secretin / Q000494:pharmacology*
D012633:Secretin; D010196:Pancreatic Elastase
Chronic pancreatitis; DWI; M-ANNHEIM clinical staging; Pancreatic gland volume; s-MRI