Secretin-enhanced MR Cholangiopancreatography: Spectrum of Findings

Tirkes, Temel; Sanyal, Rupan; Sherman, Stuart; Schmidt, C. Max; Coté, Gregory A.; Akisik, Fatih

doi:10.1148/rg.337125014

Cited by 84 publications

(51 citation statements)

References 46 publications

(52 reference statements)

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“…ERCP might be considered to further delineate anatomy, but it is not necessary when high-quality cross-sectional imaging (MRCP) is available[41]. The concurrent use of secretin has improved the diagnostic yield of MRCP and it is suggested to be valuable in assessing ductal continuity[42]. The ready availability of MRCP renders it the preferred imaging study.…”

Section: Background Datamentioning

confidence: 99%

Management of patients after recovering from acute severe biliary pancreatitis

Dedemadi

Nikolopoulos

Kalaitzopoulos

et al. 2016

WJG

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Cholelithiasis is the most common cause of acute pancreatitis, accounting 35%-60% of cases. Around 15%-20% of patients suffer a severe attack with high morbidity and mortality rates. As far as treatment is concerned, the optimum method of late management of patients with severe acute biliary pancreatitis is still contentious and the main question is over the correct timing of every intervention. Patients after recovering from an acute episode of severe biliary pancreatitis can be offered alternative options in their management, including cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy, or no definitive treatment. Delaying cholecystectomy until after resolution of the inflammatory process, usually not earlier than 6 wk after onset of acute pancreatitis, seems to be a safe policy. ERCP and sphincterotomy on index admission prevent recurrent episodes of pancreatitis until cholecystectomy is performed, but if used for definitive treatment, they can be a valuable tool for patients unfit for surgery. Some patients who survive severe biliary pancreatitis may develop pseudocysts or walled-off necrosis. Management of pseudocysts with minimally invasive techniques, if not therapeutic, can be used as a bridge to definitive operative treatment, which includes delayed cholecystectomy and concurrent pseudocyst drainage in some patients. A management algorithm has been developed for patients surviving severe biliary pancreatitis according to the currently published data in the literature.

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Section: Background Datamentioning

confidence: 99%

Management of patients after recovering from acute severe biliary pancreatitis

Dedemadi

Nikolopoulos

Kalaitzopoulos

et al. 2016

WJG

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“…IPD is less associated with pancreatitis than complete PD, since high pressure in the dorsal pancreatic duct system can decrease via a connection to the ventral duct [12, 15, 16]. …”

Section: Clinical Applicationsmentioning

confidence: 99%

Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases

et al. 2016

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MR cholangiopancreatography (MRCP) is an imaging technique that has evolved over the past 2 decades and that continues to have a fundamental role in the non-invasive detection of morphologic features of the pancreatic ducts. In several studies, MRCP has shown a good correlation with endoscopic retrograde cholangiopancreatography in the evaluation of diseases and anatomic variants of the pancreatic ductal system. However, in physiologic conditions the pancreatic ducts are not always easily recognisable. More recently, secretin-enhanced MRCP protocols have been developed for a more complete assessment of pancreatic ducts and glandular function, including monitoring of pancreatic flow dynamics and duodenal filling after pancreatic hormonal stimulation with secretin. The injection of this hormone causes temporary dilation of the pancreatic ducts, principally by increasing pancreatic exocrine secretions, and thus improving MRCP detection of the ducts and characterisation of pancreatic disorders and allowing the assessment of the exocrine pancreatic reserve. The purpose of this pictorial review is to summarise the technical aspects of secretin-stimulated MRCP, to report the secretin-stimulated MRCP findings of pancreatic duct abnormalities and to review the diagnostic capabilities of secretin-stimulated MRCP in various pancreatic ductal system conditions.Main Messages• MRCP has a fundamental role in the non-invasive detection of pancreatic ducts. • In physiologic conditions pancreatic ducts are not always well detected on MRCP. • Secretin injection causes temporary dilation of pancreatic ducts and thus improves MRCP detection. • Secretin-stimulated MRCP may allow the assessment of the exocrine pancreatic reserve. • Secretin increases the diagnostic capabilities of MRCP for evaluating pancreatic disorders.

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“…Given that MCN lesions are rare, the main diagnostic challenge is to accurately distinguish IPMN from benign cystic neoplasms of the pancreas such as serous cystadenomas. In this scenario, visualizing the communication of the lesion with the pancreatic duct is a key diagnostic feature, since it is essentially only observed in cases of side branch IPMNs (SB-IPMN) (14). …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, magnetic resonance cholangiopancreatography (MRCP) is a non-invasive and an accurate modality in detecting, localizing and classifying IPMNs (14–16). …”

Section: Introductionmentioning

confidence: 99%

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Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts

Rastegar

Matteoni-Athayde

Eng

et al. 2015

European Journal of Radiology

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Purpose We investigated the incremental diagnostic yield of S-MRCP in a population with high prevalence of small pancreatic cysts. Methods Standard MRCP protocol was performed with and without secretin using 1.5 T unites in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter Cancer of the Pancreas Screening-3 trial (CAPS 3). All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses. Result Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128 = 4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p = 0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p <0.0005). Conclusion At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions.

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Secretin-enhanced MR Cholangiopancreatography: Spectrum of Findings

Cited by 84 publications

References 46 publications

Management of patients after recovering from acute severe biliary pancreatitis

Management of patients after recovering from acute severe biliary pancreatitis

Secretin-stimulated MR cholangiopancreatography: spectrum of findings in pancreatic diseases

Incremental value of secretin-enhanced magnetic resonance cholangiopancreatography in detecting ductal communication in a population with high prevalence of small pancreatic cysts

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