Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency?: A comparison with noninvasive exocrine pancreatic function tests.

Abstract

BACKGROUND:

Data on magnetic resonance cholangiopancreatography with secretin stimulation (S-MRCP) for the assessment of exocrine pancreatic insufficiency (EPI) are limited. We compared pancreatic function tests with the findings of S-MRCP in patients with chronic pancreatitis (CP) and disease controls.

METHODS:

S-MRCP was performed in 23 patients (18 CP, 5 disease controls). MRCP images were analyzed for secretin-induced duodenal liquid filling (0=no filling; 1=duodenal bulb; 2=up to lower flexure; 3=beyond lower flexure). EPI was evaluated by fecal elastase, fecal fat concentration, and a 13C mixed chain triglyceride breath test. Clinically relevant EPI was stated if 2 of 3 tests were pathologic.

RESULTS:

EPI was diagnosed in 10 of 18 patients with CP. Patients without EPI showed either grade 2 (n=4) or grade 3 (n=9) duodenal filling, whereas only 1/10 patients with EPI showed grade 3 duodenal filling. Sensitivity and specificity of S-MRCP for the diagnosis of EPI were 69% and 90%, respectively.

CONCLUSIONS:

Assessment of duodenal filling should be performed in patients who undergo S-MRCP for the evaluation of pancreatic morphology. However, minor degrees of duodenal filling are equivocal and require further diagnostic evaluation.

• Authors: Arne R J Schneider, Renate Hammerstingl, Matthias Heller, Nada Povse, Lydia Murzynski, Thomas J Vogl, Wolfgang F Caspary, Juergen Stein
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 40 Issue 9 Pg. 851-5 (Oct 2006) ISSN: 0192-0790 [Print] United States
• PMID: 17016144 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Gastrointestinal Agents
• Secretin

Topics

• Adolescent
• Adult
• Aged
• Cholangiopancreatography, Magnetic Resonance
• Exocrine Pancreatic Insufficiency (diagnosis, physiopathology)
• Female
• Gastrointestinal Agents
• Humans
• Male
• Middle Aged
• Pancreatic Function Tests (methods)
• Pancreatitis, Chronic (diagnosis, physiopathology)
• Secretin