Diagnostic Performance of Contrast-Enhanced MRI With Secretin-Stimulated MRCP for Non-Calcific Chronic Pancreatitis: A Comparison With Histopathology

Trikudanathan, Guru; Walker, Sidney P.; Munigala, Satish; Spilseth, Benjamin; Malli, Ahmad; Han, Yusheng; Bellin, Melena D.; Chinnakotla, Srinath; Dunn, Ty B.; Pruett, Timothy L.; Beilman, Greg J.; Peralta, Jose Vega; Arain, Mustafa A.; Amateau, Stuart K.; Schwarzenberg, Sarah Jane; Mallery, Shawn; Attam, Rajeev; Freeman, Martin L.

doi:10.1038/ajg.2015.297

Cited by 53 publications

(22 citation statements)

References 45 publications

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“…Several investigations reported that the signal intensity of normal pancreatic parenchyma on T1-weighted images is typically higher than in other organs, due to the short T1 relaxation time of normal pancreatic tissue [22]. This finding is best appreciated on unenhanced, fat-suppressed, T1-weighted images [23–25]. The T1-weighted signal may be decreased in many forms of pathologies including acute and sub-acute pancreatitis in which the parenchyma becomes edematous; in chronic pancreatitis as the normal pancreatic parenchyma containing protein-rich cytoplasm becomes replaced by fibrosis and in hemochromatosis as the iron causes paramagnetic artifacts [22, 25, 26].…”

Section: Discussionmentioning

confidence: 99%

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

et al. 2016

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Purpose To determine if T1-weighted MR signal of the pancreas can be used to detect early CP. Methods A retrospective analysis was performed on 51 suspected CP patients, who had both secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and an intraductal secretin stimulation test (IDST). There were 29 patients in normal and 22 patients in the low bicarbonate group. Bicarbonate level, total pancreatic juice volume, and excretory flow rate were recorded during IDST. Signal intensity ratio of pancreas (SIR), fat signal fraction, pancreatograms findings, and grade of duodenal filling were recorded on S-MRCP by two blinded radiologists. Results There was a significant difference in the signal intensity ratio of the pancreas to spleen (SIRp/s) between the normal and low bicarbonate groups (p < 0.0001). A significant positive correlation was found between pancreatic fluid bicarbonate level and SIRp/s (p < 0.0001). SIRp/s of 1.2 yielded sensitivity of 77% and specificity of 83% for detection of pancreatic exocrine dysfunction (AUC: 0.89). Conclusion T1-weighted MR signal of the pancreas has a high sensitivity and specificity for the detection of parenchymal abnormalities related to exocrine dysfunction and can therefore be helpful in evaluation of suspected early CP.

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Section: Discussionmentioning

confidence: 99%

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

et al. 2016

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“…In addition, over the decade of our study, EUS has been further refi ned and studies support ( 41 ) its primary diagnostic role in excluding biliary tract disease and more recently chronic pancreatitis. MRCP has also undergone rapid acceptance as a diagnostic imaging modality particularly for pancreas divisum and its accuracy improved with secretin administration ( 42,43 ). Several studies suggest a higher diagnostic yield of EUS as compared with MRCP particularly to exclude biliary causes ( 44,45 ).…”

Section: Pancreas and Biliary Tractmentioning

confidence: 97%

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Wilcox

Seay

Kim

et al. 2016

American Journal of Gastroenterology

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OBJECTIVES:Although idiopathic pancreatitis is common, the natural history is not well studied, and the best diagnostic approach to both single and multiple attacks remains undefi ned. METHODS:We prospectively evaluated patients with idiopathic pancreatitis over a 10-year period, and clinical information for each episode was reviewed. Endoscopic ultrasound (EUS) was performed in all patients. Patients with microlithiasis or bile duct stones were referred for cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP), respectively. For those with a single attack, if EUS was normal or chronic pancreatitis or pancreas divisum was diagnosed, the patient was followed up for recurrence. For those with multiple attacks and a negative EUS, ERCP and sphincter of Oddi manometry with endoscopic therapy as appropriate were recommended. All patients were followed up in the long term to evaluate for recurrent pancreatitis, the primary study end point. RESULTS:Over the study period, 201 patients were identifi ed (80 single attack, 121 multiple attacks; mean age 53 years, range 17-95 years, s.d. 16.3 years; and 53% female). After EUS, 54% of patients with a single attack were categorized as idiopathic, and for multiple attacks sphincter of Oddi dysfunction (SOD) was the most common diagnosis (41%). Long-term follow-up (median 37 months; interquartile range 19-70 months) documented recurrence of pancreatitis in 15 (24%; 95% confi dence interval (CI), 15-38%) patients with a single attack and in 48 (49%; 95% CI, 38-62%) patients with multiple attacks. Despite endoscopic therapy, patients with pancreas divisum and SOD had relapse rates of 50% (95% CI, 35 to 68%) and 55% (95% CI, 31 to 82%), respectively. CONCLUSIONS: Following a single idiopathic attack of pancreatitis and a negative EUS examination, relapse was infrequent. Despite endoscopic therapy, patients with multiple attacks, especially those attributed to pancreas divisum and SOD, had high rates of recurrence. EUS may be a useful, minimally invasive tool for the diagnostic evaluation of idiopathic pancreatitis. The study was listed in Clinicaltrials.gov NCT00609726.

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“…That is why sphincter of Oddi spasm or obstructive lesions may lead to false CP diagnosis. Because of the technique performance and duration the sensitivity could be reduced [35,[46][47][48][49][50][51].…”

Section: Secretin-enhanced Mrcp (S-mrcp)mentioning

confidence: 99%

Up-To-Date View on the Clinical Manifestations and Complications of Chronic Pancreatitis

Kovacheva-Slavova¹,

Getsov²,

Vladimirov³

et al. 2019

Pancreatitis

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Chronic pancreatitis is an inflammatory disease that causes irreversible anatomical changes including infiltration of inflammatory cells, fibrosis and pancreatic calcification with destruction of the structure of the gland, leading to abdominal pain, endocrine and exocrine dysfunction. Pancreatic exocrine insufficiency (PEI) prevalence in chronic pancreatitis varies between 40 and 94%. PEI is diagnosed by direct and indirect tests. Nutritional status is assessed by anthropometric indicators; laboratory tests-hemoglobin, plasma proteins (albumin, prealbumin, retinol-binding protein, transferrin), fat-soluble vitamins A, D, E, K; micronutrients. Pancreatic enzyme replacement therapy (PERT) is a fundamental part of PEI treatment. An optimal PERT could prevent serious PEI complications such as metabolic bone disease, adverse cardiovascular events, cachexia, poor quality of life and mortality. A periodic screening for PEI complications with a respect to their primary and secondary prophylaxis is mandatory. Diabetes mellitus secondary to pancreatic disease is defined as pancreatogenic diabetes or type 3c diabetes mellitus. Patients with chronic pancreatitis are at increased risk for pancreatic cancer influenced by smoking, alcohol abuse, chronic inflammation and pancreatic stellate cells over-proliferation. However, chronic pancreatitis could be further complicated with splenic vein thrombosis, pseudocysts, duodenal or biliary obstruction, pseudoaneurysm and pancreatic duct stones which might require endoscopic or surgical treatment.

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Diagnostic Performance of Contrast-Enhanced MRI With Secretin-Stimulated MRCP for Non-Calcific Chronic Pancreatitis: A Comparison With Histopathology

Abstract: A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.

Cited by 53 publications

References 45 publications

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

Prospective Endoscopic Ultrasound-Based Approach to the Evaluation of Idiopathic Pancreatitis: Causes, Response to Therapy, and Long-term Outcome

Up-To-Date View on the Clinical Manifestations and Complications of Chronic Pancreatitis

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