Pancreas divisum and santorinicele: assessment by dynamic magnetic resonance cholangiopancreatography during secretin stimulation.

Abstract

PURPOSE:

To evaluate the usefulness of MRCP, before and after secretin administration, in diagnosing Santoriniceles in patients with pancreas divisum.

MATERIAL AND METHODS:

One hundred and eight patients with suspected pancreatic disease, underwent dynamic magnetic resonance cholangiopancreatography (MRCP) before and after secretin administration (S-MRCP). S-MRCP images were evaluated for presence/absence of pancreas divisum, Santorinicele; size of the main pancreatic duct and of the Santorinicele. The onset of duodenal filling was calculated on dynamic S-MRCP images. S-MRCP findings were compared to endoscopic retrograde cholangiopancreatography (ERCP) ones (39/108).

RESULTS:

Pancreas divisum (PD) was detected in 6/108 patients (6%) at MRCP, and in 16/108 patients (14%) at S-MRCP. ERCP confirmed the diagnosis in 12/16 patients, with 1 false positive. 3 patients did not undergo ERCP. Santorinicele was detected in 4/108 (3%) patients at MRCP and in additional 4/108 (3%) patients at S-RMCP, only in patients with PD. Santoriniceles were confirmed in 7/8 patients at ERCP; in 1/8 patient CPRE was unsuccessful. The duct of Santorini was significantly larger (p< 0.05), in the pancreatic head, in patients with PD and Santorinicele (3.6 mm) compared to those with PD only (2.2 mm). A significant reduction in size of the pancreatic duct (26%) and of the Santorinicele (63%) was observed after sphincterotomy. The onset of duodenal filling was significantly delayed in patients with Santorinicele (2.1 vs 1.3 minutes)(p<0.05).

CONCLUSIONS:

S-MRCP helps to identify patients with pancreas divisum and Santorinicele, a known cause of impeded pancreatic outflow which benefits from endoscopic treatment.

• Authors: Riccardo Manfredi, Maria Gabriella Brizi, Guido Costamagna, Gabriele Masselli, Amorino Vecchioli Scaldazza, Pasquale Marano
• Journal: La Radiologia medica (Radiol Med) 2002 Jan-Feb Vol. 103 Issue 1-2 Pg. 55-64 ISSN: 0033-8362 [Print] Italy
• PMID: 11859301 (Publication Type: Comparative Study, Duplicate Publication, Journal Article)

Chemical References

• Secretin

Topics

• Adolescent
• Adult
• Aged
• Cholangiopancreatography, Endoscopic Retrograde
• Female
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pancreas (abnormalities)
• Pancreatic Ducts (pathology)
• Secretin