Asymptomatic nonspecific serum hyperamylasemia and hyperlipasemia: spectrum of MRCP findings and clinical implications

Abstract

We assessed the magnetic resonance cholangiopancreatographic (MRCP) findings in patients with asymptomatic, mild elevations of serum amylase and lipase levels to determine whether there might be a pathoanatomic cause for these laboratory abnormalities. MRCP was performed in 633 consecutive patients. Of these, 54 (8.5%) images were obtained in patients with asymptomatic serum hyperamylasemia and hyperlipasemia. MRCP was performed on a 1.0-T MR system; breath-hold gradient-recall, half-Fourier acquisition, and rapid acquisition with relaxation enhancement sequences were obtained. Findings were verified by follow-up, biopsy, or surgery. One-sided, large-sample z tests were used to compare the incidence of abnormalities between the study and control groups (579 patients). The pancreas appeared abnormal on MRCP in 31 patients (57%), including the pancreas divisum in 10 patients (18.5%). Other findings included morphologic changes compatible with chronic pancreatitis in nine patients (16.6%) and a healed pancreatic laceration, juxtapapillary duodenal diverticulum, papillary sclerosis, intraductal pancreatic lithiasis, and hemochromatosis in one patient each (1.9%). Small cystic lesions (< 1 cm) within the pancreas were seen in 15 patients (27.8%). In eight patients, these were associated with other abnormalities (pancreas divisum in three patients, chronic pancreatitis in four, and pancreatic laceration in one). No malignancy was diagnosed. The incidences of normal examination (p = 0.01), pancreas divisum (p < 0.005), and a small cystic lesion (p = 0.01) as solitary findings in this subgroup of patients were significantly higher when compared with the remainder of the studied population. Investigation of asymptomatic patients with nonspecific hyperamylasemia and hyperlipasemia by means of MRCP yielded pancreatic findings in more than 50% of these patients. Pancreas divisum was found more often than expected in the general population.

Frequency and characteristics of pancreatitis in patients with inflammatory bowel disease

“…Therefore, false positives can occur with a 2-6% rate with MRCP and can explain a part of the 10.8% rates of ductal anomalies in this series. Moreover, in a series evaluating the accuracy of MRCP in 59 patients with hyperamylasemia or lipasemia, only 31 (57%) were found to have pancreatic duct abnormalities [34] . In the control group without hyperamylasemia or hyperlipasemia, 9.8% of the cases were suggestive of chronic pancreatitis and 4.7% had small intrapancreatic cyst !…”

“…In the control group without hyperamylasemia or hyperlipasemia, 9.8% of the cases were suggestive of chronic pancreatitis and 4.7% had small intrapancreatic cyst ! 1 cm [34].…”

Pankreatikobilyer Semptomları Olan Hastalarda İnsidental Olarak Saptanan Jukstapapiller Divertiküllerin MRCP Bulguları

“…MRCP can be useful in patients with JPD, especially for whom ERCP is technically difficult. It can demonstrate the biliary and pancreatic ducts and is proven to be useful in the detection of pancreatic disorders (29). Therefore, the indications of diagnostic ERCP can be reduced by using MRCP in these patients, and ERCP can be preserved for therapeutic purposes, or for problematic cases to confirm the MRCP findings.…”

Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance

“…On the contrary, symptoms in children are abdominal pain, an upper right abdominal mass and jaundice [3]. Pancreas divisum is more frequently seen in patients with chronic abdominal pain and in those with idiopathic or recurrent pancreatitis [4][5][6].…”

“…Negli adulti la cisti coledocica presenta una sintomatologia aspecifica che causa ritardo nella diagnosi, mentre nei bambini si manifesta con: dolore addominale, massa palpabile in ipocondrio destro ed ittero [3]. Il pancreas divisum è invece più frequentemente riscontrato in pazienti con dolore addominale cronico e nei pazienti con pancreatite idiopatica o con pancreatiti ricorrenti [4][5][6].…”