Purpose: To review magnetic resonance imaging (MRI) and secretin stimulated magnetic resonance cholangiopancreatography (S-MRCP) findings of patients with suspected chronic pancreatitis and compare them with endoscopic pancreatic function testing (ePFT).
Materials and Methods:MRI and S-MRCP findings of 36 patients with clinically suspected chronic pancreatitis were reviewed. Baseline ductal changes, duodenal filling grades, and pancreatic duct caliber change (PDC) on S-MRCP, mean values of pancreatic anteroposterior (AP) diameter, signal intensity ratio (SIR) between pancreas and the spleen on T1-weighted fat saturated images, and arterial to venous (A/V) enhancement ratios were compared between groups of normal and abnormal pancreatic exocrine function determined by ePFT.Results: All patients (n ¼ 24) with normal ePFT (HCO 3 >80 mEq/L) had grade 3 normal duodenal filling. Patients with abnormal ePFT (HCO 3 <80 mEq/L) (n ¼ 12) had grade 1 (n ¼ 1) and grade 2 (n ¼ 11) diminished duodenal filling (P < 0.0001). PDC was 1.51 in the normal ePFT group versus 1.27 in the abnormal ePFT group (P ¼ 0.01). No significant differences were found in terms of mean pancreatic AP diameter (21.8 vs. 19.8 cm), SIR (1.59 vs. 1.44), and A/V (1.08 vs. 1.01) between groups of normal/abnormal pancreatic exocrine function.
Conclusion:Despite discrepancies between pancreatic exocrine function and the findings on standard MRI/ MRCP, the S-MRCP findings are comparable to ePFT in the evaluation of chronic pancreatitis. CURRENTLY, the most sensitive diagnostic tool to detect chronic pancreatitis at its earliest stage is hormonal pancreatic function testing. Secretin stimulated endoscopic pancreatic function testing (ePFT) is considered one of the most sensitive clinical pancreatic exocrine function testing methods (1-3). Secretin stimulated magnetic resonance cholangiopancreatography (S-MRCP) can estimate pancreatic exocrine function, and at the same time an increased number of side branch ectasia and or decreased pancreatic duct compliance after secretin stimulation can be demonstrated as early imaging findings of chronic pancreatitis (4-7). In addition, there have been studies that compared pancreatic exocrine function and pancreatic parenchymal and ductal findings on magnetic resonance imaging (MRI), MRCP, ERCP, and endoscopic ultrasound (EUS). Discrepancies have been reported over the years between each imaging modality and exocrine function test (4,7-11).The purpose of this study was 2-fold; first, we compared ePFT with S-MRCP for the assessment of pancreatic exocrine function. Second, we reviewed if pancreatic exocrine function correlates with the parenchymal imaging findings on MRI and ductal changes on MRCP before and after secretin stimulation.