The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases

Chamokova, Bella; Bastati, Nina; Poetter-Lang, Sarah; Bican, Yesim; Hodge, Jacqueline C.; Schindl, Martin; Matos, Celso; Ba‐Ssalamah, Ahmed

doi:10.1259/bjr.20170677

Cited by 21 publications

(24 citation statements)

References 82 publications

(152 reference statements)

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“…Contrast-enhanced magnetic resonance cholangiopancreatography (MRCP) [Figure 5] is reported to have sensitivity of about 50–70%[60, 61, 62, 63, 64, 65]. However, individual studies have shown the sensitivity increases to up to 83–86% with a specificity of 97–99% with secretin-enhanced MRCP (S-MRCP) [Figure 6][66, 67, 68, 69, 70, 71] with systematic reviews and meta-analyses validating the results[64, 65, 72]. Secretin has also been shown to be associated with minor side effects, but generally is well tolerated with no reported events of exacerbating or precipitating pancreatic disease[71].…”

Section: Symptomatology and Diagnosismentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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Pancreas divisum, the most common congenital malformation of the pancreas, occurs due to a failure of fusion of the ductal systems of the dorsal and ventral pancreatic buds in the seventh week of intra-uterine life. This leads to a dominant dorsal pancreatic duct draining though the minor papilla and a small ventral pancreatic duct draining through the major papilla. The prevalence in western populations is about 10% and more than 95% of these patients are without pancreatic symptoms, with the anomaly found incidentally on abdominal imaging for an unrelated indication. The etiological role and clinical significance of pancreas divisum in relation to pancreatic disease has not yet been clearly defined, but may predispose to pancreatic disease in co-existence with other factors. Secretin-enhanced Magnetic Resonance Cholangiopancreatography is the non-invasive imaging modality of choice to identify pancreas divisum. Patients may be offered minor papilla therapy when they present with recurrent acute pancreatitis, severe acute pancreatitis and can be considered for therapy in the setting of chronic pancreatitis and chronic abdominal pain of pancreatic origin. Minor papilla endotherapy (sphincterotomy and/or stenting) via Endoscopic Retrograde Cholangiopancreatography and minor papilla surgical therapy have comparable outcomes with endotherapy typically considered first-line due to a favorable adverse event profile. The response to therapy is variable with maximal benefit seen in patients with recurrent acute pancreatitis and least with chronic pancreatic-type abdominal pain. Data supporting either therapy are of low quality as they are predominantly retrospective with a sub-optimal follow up period. Surgical options including a pancreatojejunostomy (Puestow or Frey procedure) or a total pancreatectomy with auto-islet cell transplantation may be considered in a subset of patients.

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Section: Symptomatology and Diagnosismentioning

confidence: 99%

Identification and management of pancreas divisum

Gutta

Fogel

Sherman

2019

Expert Review of Gastroenterology & Hepatology

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“…In addition, MR cholangiopancreatography may allow visualization of subtle dilatation of the side branches or collateral duct, suggesting a chronic fibrotic or inflammatory process rather than malignancy. Secretin-enhanced MR cholangiopancreatography may improve visualization of the duct-penetrating sign in cases of PDP (91). Figure 13 shows an approach to use when diagnosis of PDP is suspected.…”

Section: Imaging Features Of Pdpmentioning

confidence: 99%

Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach

et al. 2019

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Certain inflammatory pancreatic abnormalities may mimic pancreatic ductal adenocarcinoma at imaging, which precludes accurate preoperative diagnosis and may lead to unnecessary surgery. Inflammatory conditions that may appear masslike include massforming chronic pancreatitis, focal autoimmune pancreatitis, and paraduodenal pancreatitis or "groove pancreatitis." In addition, obstructive chronic pancreatitis can mimic an obstructing ampullary mass or main duct intraductal papillary mucinous neoplasm. Secondary imaging features such as the duct-penetrating sign, biliary or main pancreatic duct skip strictures, a capsulelike rim, the pancreatic duct-to-parenchyma ratio, displaced calcifications in patients with chronic calcific pancreatitis, the "double duct" sign, and vessel encasement or displacement can help to suggest the possibility of an inflammatory mass or a neoplastic process. An awareness of the secondary signs that favor a diagnosis of malignant or inflammatory lesions in the pancreas can help the radiologist to perform the differential diagnosis and determine the degree of suspicion for malignancy. Repeat biopsy or surgical resection may be necessary to achieve an accurate diagnosis and prevent unnecessary surgery for inflammatory conditions.

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“…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. DWI signal reflects water movement within tissue, driven by random (thermal) motion but also water diffusion between tissue compartments across cell membranes (Supplementary Material 1).…”

Section: Diffuse Pancreatic Diseasementioning

confidence: 99%

Quantitative pancreatic MRI: a pathology-based review

Chouhan

Firmin

Read

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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The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases

Cited by 21 publications

References 82 publications

Identification and management of pancreas divisum

Identification and management of pancreas divisum

Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach

Quantitative pancreatic MRI: a pathology-based review

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