Chronic Pancreatitis: Evaluation of Pancreatic Exocrine Function with MR Pancreatography after Secretin Stimulation

Abstract

Duodenal filling grade determined at MR pancreatography after secretin stimulation allows specific estimation of pancreatic exocrine function.

MRI assessment of chronic pancreatitis

“…This distension helps to visualize the pancreatic duct. Secretin is a safe pharmaceutical agent with a very small incidence of serious adverse effects and is easy to administer (11)(12)(13).…”

Magnetic Resonance Cholangiopancreatography Reports in the Evaluation of Chronic Pancreatitis: A Need for Quality Improvement

“…Recent studies have attempted to quantify the changes seen on MRCP and sMRCP in hopes of better diagnosing early chronic pancreatitis [14,15,16,17,18]. Numerous static and dynamic features of MRI have been studied to try and better diagnose early chronic pancreatitis.…”

Diagnosis of mild chronic pancreatitis (Cambridge classifi cation): Comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography

“…ERCP is the sensitive method for the diagnosis of earlystage chronic pancreatitis [19][20][21] ; however, it is invasive and associated with complications [22,23] , because sufficient contrast medium must be injected to the peripheral branches of the pancreatic ducts when mild changes of chronic pancreatitis are sought [24] . Today, diagnostic ERP is challenged by MRCP, which is a noninvasive alternative to diagnostic ERP for the evaluation of normal and diseased pancreatic ducts [5][6][7][8][9] . However, it is difficult to delineate minimally dilated branch pancreatic ducts on MRCP despite its improved resolution because while on ERCP images the collapsed branches and main pancreatic duct are distended by the contrast medium, MRCP reflects the physiologic state of the pancreatic duct.…”

“…Secretin stimulates fluid secretion in the ductal system; and increases the tonus of the sphincter of Oddi during the first 5 min, inhibiting the release of fluid through the papilla of Vater [9] . Therefore, secretin increases the absolute volume of intraductal free water and fills the collapsed branches with fluid [10] , facilitating the detection of mild ductal changes in patients with mild chronic pancreatitis, even when no abnormalities can be demonstrated by MRCP under physiologic conditions.…”

“…MR cholangiopancreatography (MRCP) is a useful non-invasive technique to depict the projection images of the pancreatico-biliary tree, and is expected to become a valuable alternative to endoscopic retrograde cholangiopancreatog raphy (ERCP) [3][4][5][6][7][8] . However, visualization of the branch pancreatic ducts by MRCP is not good [9][10][11] , and there are few reports about the diagnostic value of MRCP in mild chronic pancreatitis (Cambridge classification). On the other hand, secretin injection-MRCP might allow better visualization of the pancreatic ductal system [12][13][14][15][16] .…”