Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results

Abstract

The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP.

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“…The volume of pancreatic duct fluid, collected from the operating room in this study, is well within the volume that can be collected during ERCP following secretin stimulation. 38,39 The National Familial Pancreas Tumor Registry (NFPTR) tracks such families and analysis clearly demonstrates a prospective increased risk in first-degree relatives. 2,40 In Peutz-Jeghers syndrome, Giardiello's group has reported a 130 fold increased (95% CI, 44-261) relative risk of pancreatic cancer.…”

Secretin-enhanced Magnetic Resonance Cholangiopancreatography in Pancreatic Insufficient and Pancreatic Sufficient Cystic Fibrosis Patients

“…This increases its diagnostic potential in early and mild pancreatitis [27], as well as in congenital abnormalities, such as the pancreas divisum [28]. Different teams elaborated protocols in which SE-MRCP is used to assess the pancreatic fluid volume [29][30][31][32][33], which provides additional information on exocrine pancreatic function.…”

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

“…Fecal fat concentration and a 13 C mixed-chain triglyceride breath test have also been compared to MRCP [9]. Dynamic changes including pancreatic exocrine secretions (quantified by pancreatic flow output and total excreted volume) have also been evaluated [6,21]. The Mayo Clinic group has reported that combining both endoscopic ultrasound and MRCP is highly predictive of early chronic pancreatitis and ERCP is unlikely to add any useful information [1].…”

“…Magnetic resonance imaging (MRI) and variations in image processing such as diffusion weighting, dynamic thick slab and 3-D reconstruction are emerging as diagnostic tools to evaluate patients with suspected pancreatic disease [6]. MRI has a large appeal to generalists and subspecialists since it is completely non-invasive and does not induce procedure-related pancreatitis as its endoscopic counterpart – retrograde pancreatogram [7].…”