MRI and S‐MRCP findings in patients with suspected chronic pancreatitis: Correlation with endoscopic pancreatic function testing (ePFT)

Abstract

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.

Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease

“…Abnormal endoscopic pancreatic function testing (ePFT) results have been reported to correlate moderately with diminished arterial perfusion 25. Secretin magnetic retrograde cholangiopancreatography (s-MRCP) has also been used to evaluate both the exocrine function of the pancreas and pancreatic duct compliance, thus excluding potential early structural changes not seen on MRI and MRCP.…”

Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature

“…Prediction of PEI by magnetic resonance imaging and endoscopic ultrasound is, as of now, limited to conservatively managed patients with chronic pancreatitis [51][52][53][54].…”

Correlation between secretin-enhanced MRCP findings and histopathologic severity of chronic pancreatitis in a cat model

“…Currently, endoscopic pancreatic function testing (ePFT) is considered the most reliable test for exocrine pancreatic function, but it is invasive and time-consuming [12]. In recent years, it has been reported that the efficacy of S-MRCP is comparable to that of ePFT in the evaluation of CP [12,18], and the assessment of exocrine pancreatic function using S-MRCP is highly correlated with tubeless tests (that is, FE-1 and pancreolauryl) [1]. Demonstrating a correlation between S-MRCP findings and CP histopathology will further support the use of S-MRCP for judging the severity in this disease.…”