Purpose: To review magnetic resonance imaging (MRI) and secretin stimulated magnetic resonance cholangiopancreatography (S-MRCP) findings of patients with suspected chronic pancreatitis and compare them with endoscopic pancreatic function testing (ePFT). Materials and Methods:MRI and S-MRCP findings of 36 patients with clinically suspected chronic pancreatitis were reviewed. Baseline ductal changes, duodenal filling grades, and pancreatic duct caliber change (PDC) on S-MRCP, mean values of pancreatic anteroposterior (AP) diameter, signal intensity ratio (SIR) between pancreas and the spleen on T1-weighted fat saturated images, and arterial to venous (A/V) enhancement ratios were compared between groups of normal and abnormal pancreatic exocrine function determined by ePFT.Results: All patients (n ¼ 24) with normal ePFT (HCO 3 >80 mEq/L) had grade 3 normal duodenal filling. Patients with abnormal ePFT (HCO 3 <80 mEq/L) (n ¼ 12) had grade 1 (n ¼ 1) and grade 2 (n ¼ 11) diminished duodenal filling (P < 0.0001). PDC was 1.51 in the normal ePFT group versus 1.27 in the abnormal ePFT group (P ¼ 0.01). No significant differences were found in terms of mean pancreatic AP diameter (21.8 vs. 19.8 cm), SIR (1.59 vs. 1.44), and A/V (1.08 vs. 1.01) between groups of normal/abnormal pancreatic exocrine function. Conclusion:Despite discrepancies between pancreatic exocrine function and the findings on standard MRI/ MRCP, the S-MRCP findings are comparable to ePFT in the evaluation of chronic pancreatitis. CURRENTLY, the most sensitive diagnostic tool to detect chronic pancreatitis at its earliest stage is hormonal pancreatic function testing. Secretin stimulated endoscopic pancreatic function testing (ePFT) is considered one of the most sensitive clinical pancreatic exocrine function testing methods (1-3). Secretin stimulated magnetic resonance cholangiopancreatography (S-MRCP) can estimate pancreatic exocrine function, and at the same time an increased number of side branch ectasia and or decreased pancreatic duct compliance after secretin stimulation can be demonstrated as early imaging findings of chronic pancreatitis (4-7). In addition, there have been studies that compared pancreatic exocrine function and pancreatic parenchymal and ductal findings on magnetic resonance imaging (MRI), MRCP, ERCP, and endoscopic ultrasound (EUS). Discrepancies have been reported over the years between each imaging modality and exocrine function test (4,7-11).The purpose of this study was 2-fold; first, we compared ePFT with S-MRCP for the assessment of pancreatic exocrine function. Second, we reviewed if pancreatic exocrine function correlates with the parenchymal imaging findings on MRI and ductal changes on MRCP before and after secretin stimulation.
Purpose: To review pancreatic MRI findings and their relationship with estimated pancreatic exocrine function on secretin-stimulated MR cholangiopancreatography (S-MRCP) in patients with clinically suspected chronic pancreatitis and normal baseline MRCP findings. Materials and Methods:MRI findings of 26 patients with normal pancreatic duct diameter and without side branch ectasia on MRCP were evaluated. A single radiologist assessed pancreatic size, pancreatic signal intensity ratio (SIR), and arterial enhancement ratio (A/V) at head, body, and tail of the pancreas on T 1 -weighted fat-suppressed and serial contrast-enhanced images at a single session. Combined findings were graded with a composite score. Serial S-MRCP was performed at the same session with standard MRI. Correlation and differences between MRI findings and associated grade of duodenal filling (DF) or the degree of pancreatic duct caliber change (PDC) were analyzed.Results: Seven patients revealed normal and 19 patients abnormal MRI findings. Significant correlation was present between the degree of DF and mean values of pancreatic size (r ϭ 0.748), SIR (r ϭ 0.610), A/V (r ϭ 0.466), composite score (r ϭ 0.833), and PDC (r ϭ 0.554) separately. PDC correlated with SIR (r ϭ 0.413) and composite score (r ϭ 0.452), but not with A/V or pancreatic size. Significant differences were present between normal and abnormal DF grades in terms of mean values of associated findings of size (P ϭ 0.001), SIR (P ϭ 0.008), A/V (P ϭ 0.019), and PDC (P ϭ 0.001). Conclusion:Patients with clinically suspected chronic pancreatitis and normal MRCP findings may have a spectrum of MRI findings that correlate with the estimated pancreatic exocrine insufficiency on S-MRCP with the increasing number of combined findings. PATIENTS WITH CLINICALLY suspected chronic pancreatitis undergo imaging and/or pancreatic function testing to rule out early chronic pancreatitis. Pancreatic exocrine insufficiency determined by secretin-stimulated pancreatic function testing is a very sensitive marker for the diagnosis of early chronic pancreatitis (1). Abnormal results in pancreatic function testing precede imaging findings in cases with mild early chronic pancreatitis (2). The Cambridge classification system has been used for the diagnosis and staging of chronic pancreatitis on imaging studies. Patients with normal pancreatic duct on endoscopic retrograde cholangiopancreatography (ERCP) are considered normal according to that classification (3). ERCP is the most sensitive imaging method for the evaluation of pancreatic duct and its side branches. Despite of its high sensitivity, ERCP is less frequently used for screening patients with clinical symptoms of chronic pancreatitis because the test is invasive and costly. Besides, normal ERCP cannot exclude early changes of chronic pancreatitis (1,4). MR cholangiopancreatography (MRCP) as a noninvasive test has been increasingly used to rule out chronic pancreatitis and replaced the role of ERCP for screening. According to the most recent studies...
The spectrum of MRI and MRCP findings in HIV-infected patients includes acute or chronic hepatitis (or both), pancreatitis, cholangitis, acalculous cholecystitis, and biliary strictures that may resemble primary sclerosing cholangitis. The presence of segmental extrahepatic biliary strictures is characteristic of AIDS cholangiopathy.
The spectrum of imaging findings of focal pancreatitis on MRI/MRCP including DWI was described. Findings of FP were not distinctive as compared to the remaining pancreas.
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