Collateral branches IPMTs: secretin-enhanced MRCP

Abstract

Recently, the fantastic evolution of imaging modalities (especially MR, MDCT, EUS) has raised many issues regarding the correct classification of smaller and smaller lesions, their preoperative evaluations, and indications of most appropriate treatment. However, it is still debated which technique should be employed for the diagnosis and the follow-up of intraductal papillary mucinous tumours (IPMTs). Despite the superb spatial resolution of MDCT, nowadays most of the authors agree on considering MR with magnetic resonance cholangiopancreatography (MRCP) the imaging modality of choice in studying IPMTs. In particular, MRCP is rapid, non-invasive, and accurate in detecting, localizing, and correctly classifying IPMT. The diagnostic performance of MRCP is even improved after the introduction of secretin stimulation. In fact, dynamic MRCP studies after secretin administration, besides facilitating the depiction of the structural characteristics of the lesions, make easier the detection of the communicating duct of branch duct IPMTs with the main pancreatic duct, especially if the newest high resolution 3D heavily T2-weighted sequences are utilized. Secretin stimulation is also useful in the demonstration of early changes of associated chronic pancreatitis. Consequently, we believe that secretin-enhanced MRCP is the most suitable imaging modality in the diagnosis and follow-up of IPMTs of the collateral branches.

Pancreatic and extrapancreatic lesions in patients with intraductal papillary mucinous neoplasms of the pancreas: a single-centre experience

“…All patients fasted for at least 5 h before the examination, and approximately 200 ml of superparamagnetic contrast medium (Ferumoxsil Lumirem, Guerbet S.p.A., Genova, Italy) or pure pineapple juice was given orally 30 min before the procedure to elim-(MRCP) la tecnica radiologica più idonea sia per la diagnosi (in questo caso la MRCP deve essere eseguita con stimolo secretinico) che per il follow-up (solitamente la MRCP può essere eseguita senza stimolo secretinico) [19,22,23]. Nella nostra esperienza per la diagnosi di NPI si dovrebbe utilizzare la tomografia computerizzata multidetettore (MDCT), mentre la tecnica di imaging di scelta per il follow-up è la MRCP con o senza secretina [24].…”

“…There is no evidence in the literature indicating the best imaging modality for following up IPMNs, although many authors consider magnetic resonance cholangiopancreatography (MRCP) to be the most suitable imaging technique for diagnosis (with secretin administration) and follow-up (without secretin administration) for managing branch ductal type [19,22,23]. In our experience, a diagnosis of IPMNs is made using multidetector computed tomography (MDCT), [4].…”

The diagnostic MRCP examination: overcoming technical challenges to ensure clinical success

“…The main aim of this classic MRCP sequence is to demonstrate ductal fluid as hyperintense while filling defects, such as those caused by stones, are displayed as hypointense [12]. Traditionally, a set of radially oriented thick slab MRCP images were obtained and may still be the case in many centres [44, 47]. It has been somewhat successful and so it is understandable that centres continue to use this approach.…”

“…Studies have demonstrated that the intravenous administration of secretin has the effect of allowing the main pancreatic duct to fill with fluid and therefore become more readily identifiable [41-44] while another study has claimed success with the use of intravenous morphine [19]. Time is yet to determine whether these approaches will be routinely performed in the broad clinical setting.…”

Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts

“…Secretin increases the caliber of the pancreatic duct, permitting better assessment of ductal strictures, irregularities and anatomic variants. It has also been recently demonstrated to be of value in patients with pancreatitis (3) Secretin-enhanced MRCP may also delineate to a better degree the communication of a cystic lesion with the ductal system, allowing accurate diagnosis of IPMNs (15,16). The purpose of our study was, therefore, to evaluate the incremental value of secretin-enhanced MRCP (S-MRCP) in detecting ductal communication in a population with high prevalence of small pancreatic cysts.…”