Evaluation of pancreatic exocrine insufficiency by cine-dynamic MRCP using spatially selective inversion-recovery (IR) pulse: Correlation with severity of chronic pancreatitis based on morphological changes of pancreatic duct

Yasokawa, Kazuya; Ito, Katsuyoshi; Kanki, Akihiko; Yamamoto, Akira; Torigoe, Teruyuki; Sato, Takahiro; Tamada, Tsutomu

doi:10.1016/j.mri.2017.12.007

Cited by 11 publications

(11 citation statements)

References 19 publications

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“…There is ample available evidence in the literature that MRI and MRCP are useful tools for diagnosing CP, as they have been shown to correlate with patient symptoms [27], fecal elastase [28,29], histopathology [30] and a variety of other disease markers [31,32]. However, even high quality MRCP scans with good spatial resolution do not always depict dilated side branches, and MRCP findings do not always correlate well with exocrine function of the gland [33,34]. On the other hand, ERCP as a standard for grading of CP also carries limitations, chief among which is that ERCP does not mimic physiologic conditions.…”

Section: Direct Comparison Of Mrcp and Ercp Based Cambridge Scoresmentioning

confidence: 99%

Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards

et al. 2020

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Grading of chronic pancreatitis (CP) is a clinical and radiologic challenge. Retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP) use a version of the Cambridge criteria for ductal evaluation and CP staging, but interchangeability between the modalities lacks validation. This work compares ERCP and MRCP Cambridge scores and evaluates diagnostic performance of MRCP in a large cohort of patients with CP. MethodsA large radiology database was searched for CP patients who underwent MRCP between 2003 and 2013. Next, patients who also had an ERCP within 90 days of their MRCP were selected.These were categorized into mild, moderate, and severe CP using the standardized Cambridge classification for ERCP. Radiologists blinded to ERCP findings then rated MRCP with modified Cambridge scores. ResultsThe cohort comprised of 325 patients (mean age 51 years; 56% female). By ERCP Cambridge classification, 122 had mild CP, 109 moderate CP, and 94 severe CP. MRCP and ERCP showed total agreement of Cambridge score in only 43% of cases. With ERCP as reference, the

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Section: Direct Comparison Of Mrcp and Ercp Based Cambridge Scoresmentioning

confidence: 99%

Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards

et al. 2020

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“…This has been used to develop a 5 point grading system that correlates with Cambridge CP scores (r = −0.698, p < 0.001). 17 The use of secretin MRCP is unfortunately limited by supply shortages and its significant cost. 18 While a number of quantitative metrics have been proposed, a consensus around methodology, metrics and cut off levels is lacking, and will need to be defined for multicentre formal evaluation studies and more widespread adoption.…”

Section: Diffuse Pancreatic Diseasementioning

confidence: 99%

Quantitative pancreatic MRI: a pathology-based review

Chouhan

Firmin

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et al. 2019

The British Journal of Radiology

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MRI plays an important role in the clinical management of pancreatic disorders and interpretation is reliant on qualitative assessment of anatomy. Conventional sequences capturing pancreatic structure can however be adapted to yield quantitative measures which provide more diagnostic information, with a view to increasing diagnostic accuracy, improving patient stratification, providing robust non-invasive outcome measures for therapeutic trials and ultimately personalizing patient care. In this review, we evaluate the use of established techniques such as secretin-enhanced MR cholangiopancreatography, diffusion-weighted imaging, T 1, T 2* and fat fraction mapping, but also more experimental methods such as MR elastography and arterial spin labelling, and their application to the assessment of diffuse pancreatic disease (including chronic, acute and autoimmune pancreatitis/IgG4 disease, metabolic disease and iron deposition disorders) and cystic/solid focal pancreatic masses. Finally, we explore some of the broader challenges to their implementation and future directions in this promising area.

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“…In addition, cine‐dynamic MRCP with a spatially selective IR pulse technique has been applied in several clinical investigations. For instance, it has been reported that this technique was useful for the early diagnosis of chronic pancreatitis as well as the assessment of its severity 6,7 . Another study showed that antegrade bile flow was observed more frequently in patients after cholecystectomy, probably due to the increased internal pressure of the extrahepatic bile duct 8 .…”

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confidence: 99%

Pancreatobiliary Flow Dynamics: Association Between Bile and Pancreatic Juice Evaluated With Cine‐Dynamic Magnetic Resonance Cholangiopancreatography Using Spatially Selective Inversion Recovery Pulse

Higashi

Tanabe

Ihara

et al. 2021

Magnetic Resonance Imaging

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Background The physiological flow patterns and the reciprocal relationship between pancreatic juice and bile excretion dynamics have not been clearly elucidated by imaging. Purpose To assess the physiological flow patterns of bile and pancreatic juice simultaneously in order to clarify the pancreatobiliary flow dynamics using cine‐dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatial selective inversion recovery (IR) pulse. Study Type Retrospective. Population A total of 85 patients with physiologically normal pancreatobiliary flow without ductal dilatation (normal group) and 19 patients with dilated pancreatic duct. Field Strength/Sequence A 3 T, fast spin echo sequence with IR pulse to nullify the signal of static pancreatic juice and bile. Assessment The frequency and secretion grade of the antegrade and reverse flow of the pancreatic juice and bile on cine‐dynamic MRCP were visually evaluated. Additionally, the reciprocal relationship between pancreatic juice and bile flow was evaluated based on its flow patterns. Statistical Tests Spearman's rank correlation coefficient analysis and the Kruskal–Wallis and Mann–Whitney U tests were used. P values of <0.05 were considered to indicate statistical significance. Results In the normal group, the antegrade pancreatic juice flow and no bile flow pattern was most frequently observed (29%), followed by the no pancreatic juice flow and no bile flow pattern (23%), the antegrade pancreatic juice flow and antegrade bile flow pattern (22%), and the no pancreatic juice flow and reverse bile flow pattern (9%). The flow of the pancreatic juice and bile were synchronized with each other in 47%, while they were not in 53%. In the dilated pancreatic duct group, the mean secretion grade of the antegrade bile and pancreatic juice flow was significantly lower than in the normal group. Data Conclusion Cine‐dynamic MRCP with a spatially selective IR pulse can visualize the variations of the physiological flow patterns of bile and pancreatic juice including 53% of unsynchronized patterns. Level of Evidence 4 Technical Efficacy Stage 5

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Evaluation of pancreatic exocrine insufficiency by cine-dynamic MRCP using spatially selective inversion-recovery (IR) pulse: Correlation with severity of chronic pancreatitis based on morphological changes of pancreatic duct

Cited by 11 publications

References 19 publications

Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards

Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards

Quantitative pancreatic MRI: a pathology-based review

Pancreatobiliary Flow Dynamics: Association Between Bile and Pancreatic Juice Evaluated With Cine‐Dynamic Magnetic Resonance Cholangiopancreatography Using Spatially Selective Inversion Recovery Pulse

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