Secretin-Enhanced MRCP: How and Why—AJR Expert Panel Narrative Review

Abstract

Secretin-enhanced MRCP (S-MRCP) provides multiple advantages compared with standard MRCP for imaging the pancreaticobiliary tree. By using secretin to induce fluid production from the pancreas, and leveraging fluid-sensitive MRCP sequences, S-MRCP increases visualization of ductal anatomy and provides insight into pancreatic function, allowing radiologists to offer additional insight for a range of pancreatic-related conditions. This narrative review provides detailed information on the practical implementation of S-MRCP, including patient preparation, logistics of secretin administration, and dynamic secretin-enhanced MRCP acquisition. Considerations are given for radiologists' interpretation and reporting of S-MRCP examinations, including assessment of dynamic compliance of the main pancreatic duct and of duodenal fluid volume. Established indications for S-MRCP are reviewed, including pancreas divisum, anomalous pancreaticobiliary junction, Santorinicele, Wirsungocele, chronic pancreatitis, main pancreatic duct stenosis, and assessment of complex postoperative anatomy. Equivocal or controversial indications are also presented, along with the authors' approach to such indications; these include acute or recurrent acute pancreatitis, pancreatic exocrine function, sphincter of Oddi dysfunction, and pancreatic neoplasms.

Management of chronic pancreatitis

“…MRI and magnetic resonance cholangiopancreatography (MRCP) have an additional advantage of detecting ductal changes in addition to parenchymal changes 7980. Also, the administration of secretin to stimulate fluid secretion during an MRCP can further define pancreatic function and ductal pathology 81828384. Of note, in addition to developing circulating biomarkers for the diagnosis of chronic pancreatitis, the Consortium on Chronic Pancreatitis, Diabetes and Pancreatic Cancer is greatly involved in advancing quantitative MRI for improved diagnostic ability in different stages of chronic pancreatitis, taking advantage of the unique T1 relaxation of the pancreas owing to its high protein content and the ability of MRI to measure extracellular volume (equivalent to fibrosis) and the presence of fat 708586.…”

Comprehensive Review on Pancreatic Head Cancer: Pathogenesis, Diagnosis, and Treatment Challenges in the Quest for Improved Survival

“…Magnetic resonance cholangiopancreatography (MRCP) is a specialized type of MRI used to examine pancreatic tumours and blockage [ 32 ] accurately. EUS has been more precise in identifying cancer than all other screening methods [ 33 ].…”

“…Radiotherapy is seen to be very useful in patients with localized pancreatic cancer [ 1 , 32 ]. External beam radiation therapy is the most used for pancreatic head carcinoma.…”

Screening of pancreatic cancer: Target population, optimal timing and how?

“…The MRI can also detect other abdominal tumors besides pancreatic tumors, which may occur in high-risk individuals [ 17 , 37 ]. The use of MRCP may be useful in evaluating pancreatic ductal abnormalities, and in some cases, secretin can be injected to improve diagnostic accuracy [ 38 ]. Nowadays, EUS and MRI are preferred compared to CT scans due to the lack of radiation exposure for patients and higher sensitivity in detecting small pancreatic lesions [ 18 , 39 ].…”