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

Abstract

AIM:To investigate the usefulness of secretin injection-MRCP for the diagnosis of mild chronic pancreatitis. METHODS:Sixteen patients having mild chronic pancreatitis according to the Cambridge classification and 12 control subjects with no abnormal findings on the pancreatogram were examined for the diagnostic accuracy of secretin injection-MRCP regarding abnormal branch pancreatic ducts associated with mild chronic pancreatitis (Cambridge Classification), using endoscopic retrograde cholangiopancreatography (ERCP) for comparison. RESULTS:The sensitivity and specificity for abnormal branch pancreatic ducts determined by two reviewers were respectively 55%-63% and 75%-83% in the head, 57%-64% and 82%-83% in the body, and 44%-44% and 72%-76% in the tail of the pancreas. The sensitivity and specificity for mild chronic pancreatitis were 56%-63% and 92%-92%, respectively. Interobserver agreement (κ statistics) concerning the diagnosis of an abnormal branch pancreatic duct and of mild chronic pancreatitis was good to excellent. CONCLUSION:Secretin injection-MRCP might be useful for the diagnosis of mild chronic pancreatitis. Comparative study using secretin injection-magnetic resonance c h o l a n g i o p a n c r e a t o g r a p h y a n d e n d o s c o p i c r e t r o g r a d e pancreatography.

State-of-the-Art Pancreatic MRI

“…Conventional MRCP is not sensitive to the diagnosis of mild chronic pancreatitis. S-MRCP helps in assessing early side branch dilation of this condition [33][34][35][36] (Fig. 15).…”

MRI assessment of chronic pancreatitis

“…When additional calculi and obstructions, cysts, and/or stenosis of the main pancreatic duct are present, these changes are lead to classification as Cambridge stage 5 ( Fig. 1) (8).…”

“…The presence of periductal fibrosis results in traction of the main pancreatic duct and its side branches, causing dilatation of the main pancreatic duct and its side branches (5)(6)(7)(8). Pancreatic ductal findings regarding chronic pancreatitis are evaluated by MRCP according to the Cambridge classification, as shown in Table. Normal pancreatic ductal anatomy, without side branch ectasias, is considered Cambridge stage 1.…”

Структурна Трансформація Протокової Системи Підшлункової Залози У Хворих На Хронічний Панкреатит

“…Одним из первых признаков ХП является именно анормальное увеличение количества бранчей протоков, которое выявляется на ретроградной холан-гиопанкреатографии [9]. Также доказано, что у паци-ентов с ХП в протоках увеличивается число клеток, со-держащих инсулин, а также клеток, которые содержат другие эндокринные и экзокринные маркеры [10].…”