Sensitivity of Endoscopic Ultrasound, Multidetector Computed Tomography, and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum

Abstract

OBJECTIVES There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: 1. Evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and multi-detector computed tomography (MDCT) for pancreas divisum. 2. Assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP. METHODS For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography (ERP) who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent ERP and cross-sectional imaging. RESULTS The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) [p<0.001 for each]. On review by expert radiologists the sensitivity of MDCT increased to 83.3% in cases where the pancreatic duct was visualized, with fair IOA (қ=0.34). Expert review of MRCPs did not identify any additional cases of pancreas divisum; IOA was moderate (қ=0.43). CONCLUSIONS EUS is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.

ERCP in Other Pancreatic Disorders

“…If it cannot be seen, is that because PD is present or the duct is just tortuous and cannot be kept in the plane of imaging? Despite these potential problems, a recent study compared the sensitivity of EUS, CT, and MRCP for the diagnosis of PD and investigators found the sensitivity for EUS to be 86.7 %, which was significantly higher than that of CT and MRCP [22].…”

The role of endoscopy in benign pancreatic disease

“…25,26 Magnetic resonance imaging (MRI) is considered sensitive for the detection of divisum, particularly when secretin is administered before the study. 27 However, the sensitivity of MRI for the detection of divisum is lower in those with CP. 28 EUS may be superior to multidetector CT or MRI without secretin for detection of divisum.…”

“…28 EUS may be superior to multidetector CT or MRI without secretin for detection of divisum. 27 Pancreatography is considered the best method for establishing the presence of divisum; however, ERP via the minor papilla should not be offered only for diagnostic purposes. ERP with minor papillotomy may prevent further attacks of acute recurrent pancreatitis in certain patients with divisum, yet there are no prospective, randomized, controlled trials that confirm this hypothesis.…”

Pancreas divisum: a reemerging risk factor for pancreatic diseases

“…This image is obtained by the injection of a contrast agent into the main pancreatic duct and common bile [32]. Nowadays, due to the availability of modern noninvasive imaging modalities such as abdominal ultrasound (AUS), computed tomography (CT), MRCP and EUS (Table 1) ERCP has transformed from a diagnostic technique to mostly a therapeutic procedure [26,29,[33][34][35][36][37][38][39].…”