Sonographic imaging of the pancreatic duct

Glaser, Joachim; Högemann, B.; Krummenerl, Thomas; Schneider, Michael; Hultsch, Ekhard; Husen, N. van; Gerlach, U

doi:10.1007/bf01300191

Cited by 53 publications

(11 citation statements)

References 11 publications

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“…These results are similar to those in previous articles (15,23) about US and MRCP. This is explained by the fact that intravenous administration of a bolus of secretin induces increased tonus of the sphincter of the hepatopancreatic ampulla (Oddi sphincter) during the first 5-6 minutes, and the tonus of the sphincter decreases after that time (24).…”

Section: Discussionsupporting

confidence: 93%

“…These results suggest that MRCP with secretin stimulation may not be adequate for the assessment of the undilated accessory pancreatic duct and branch ducts, although it may be useful in the assessment of the main pancreatic duct. The degree of duct dilatation depends on the rate of secretion of pancreatic juice, the volume of the ductal system, the compliance of the duct, and intraduodenal pressure, in addition to the resistance of the pancreatic duct sphincter (23). In this study, a significant increase in the diameter of the normal pancreatic duct and improvement in its visualization at MRCP, especially 4 -5 minutes after the administration of secretin, were observed.…”

Section: Discussionsupporting

confidence: 52%

“…The limitation of our study was that results from only 43 of 85 patients with a normal pancreas could be correlated with ERCP images, so the group of patients with a normal pancreas in this study might include some patients with mild chronic pancreatitis. The more tardy dilatation after secretin administration seen in our patients with a normal pancreas may be due to their older ages, because periductal fibrosis seen in advanced age reduces the flexibility of the pancreatic duct (23).…”

Section: Discussionmentioning

confidence: 77%

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Pancreatic Duct: Morphologic Evaluation with MR Cholangiopancreatography after Secretin Stimulation

Fukukura¹,

Fujiyoshi²,

Sasaki³

et al. 2002

Radiology

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 77%

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Pancreatic Duct: Morphologic Evaluation with MR Cholangiopancreatography after Secretin Stimulation

Fukukura¹,

Fujiyoshi²,

Sasaki³

et al. 2002

Radiology

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“…We used the post‐ to presecretin pancreatic duct diameter ratio for the evaluation of PDC. Reduced PDC is associated with the presence of fibrosis (34). Previous reports indicated that patients with chronic pancreatitis have increased baseline diameter that did not increase after secretin stimulation (8).…”

Section: Discussionmentioning

confidence: 99%

Suspected chronic pancreatitis with normal MRCP: Findings on MRI in correlation with secretin MRCP

Balci

Alkaade

Magas

et al. 2007

Magnetic Resonance Imaging

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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...

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“…An increase in pancreatic duct diameter is expected with secretin stimulation. PDC expressed as a percentage of variation of duct diameter from baseline is reduced in chronic pancreatitis secondary to fibrosis (32.2%) as compared with normal controls (66.5%) [1, 3, 21••, 25,26]. Rapid injection of secretin gives a secretory peak after 4 min, morphologically documented by transient dilatation of the main pancreatic duct.…”

Section: Mri/mrcp With Secretin Stimulationmentioning

confidence: 99%

Advanced Imaging of Chronic Pancreatitis

Choueiri

Balci

Alkaade

et al. 2010

Curr Gastroenterol Rep

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Chronic pancreatitis is characterized by continuing inflammation, destruction, and irreversible morphological changes in the pancreatic parenchyma and ductal anatomy. These changes lead to chronic pain and/or loss of function. Although these definitions are simple, the clinical diagnosis of chronic pancreatitis remains difficult to make, especially for early disease. Routine imaging modalities such as transabdominal ultrasound and standard CT scans are insensitive for depicting early disease, and detect only advanced chronic pancreatitis. Advances in imaging modalities including CT, MRI with gadolinium contrast enhancement, MRI with magnetic resonance cholangiopancreatography (MRI/MRCP), MRI/MRCP with secretin-stimulation (S-MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) allow earlier diagnosis of chronic pancreatitis. This article reviews the recognized findings, advantages, and disadvantages of the various imaging modalities in the management of chronic pancreatitis, specifically CT, MRI with or without MRCP and/or S-MRCP, ERCP, and EUS.

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Sonographic imaging of the pancreatic duct

Cited by 53 publications

References 11 publications

Pancreatic Duct: Morphologic Evaluation with MR Cholangiopancreatography after Secretin Stimulation

Pancreatic Duct: Morphologic Evaluation with MR Cholangiopancreatography after Secretin Stimulation

Suspected chronic pancreatitis with normal MRCP: Findings on MRI in correlation with secretin MRCP

Advanced Imaging of Chronic Pancreatitis

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