Purpose
According to guidelines for diagnostic cross sectional imaging and severity scoring in chronic pancreatitis (CP) published in 2018, the diagnosis of early CP is challenging based on all imaging modalities, including endoscopic retrograde cholangiopancreatography (ERCP), which has been considered to be the golden standard. In adition, ERCP, endoscopic ultrasound and direct pancreatic function tests are invasive and sensitivity of the practical non-invasive tests has been found to be inadequate [1]. No uniform imaging definition for early CP incorporating non-invasive imaging techniques currently exists [1,2,3].
Magnetic...
Methods and materials
SUBJECTS
20 patients were referred to the MRCP-S at our institution on a conventional 1,5T MRI scanner. The refferal diagnosis was as following:
4 patients (23.5 %) had clinical suspicion of early PEI,
1 patient (5.9 %) had known CP on enzyme substitution therapy, and
in 12 patients (70.6 %) normal pancreatic exocrine function was suspected (healthy controls).
Patients were divided into three groups according to fecal elastase-1 (FE-1) levels:
group 1 with FE-1 >200 µg/g (normal exocrine function),
group 2 with FE-1 between 15-200...
Results
PATIENTS
Conventional MRCP was performed in all 20 patients (10 male, 10 female; median age, 59.0 years [range 24.5 – 71.7 years]; median body weight, 70 kg [range 61-102 kg]). Overall, secretin was applied to 17 of 20 patients (85%); the remaining 2 patients (10%) had contraindications to secretin application (acute pancreatitis) and 1 patient (5%) refused the application.
Median dose of intravenously applied secretin was 7 ml (range, 6-10 ml).
No patient showed elevated amylase and/ or lypase levels after MRCP-S, and none of...
Conclusion
In patients with CP, MPD compliance disorders present as lesser degree of MPD dilatation and/or delayed or no returning to normal after secretin stimulation [1,5].
In our preliminary study, lower FE-1 values borderline significantlly correlated with no or minimal MPD dilatation. Although not significant, the same patients also showed delayed duodenal filling after application of secretin. Since lower values of FE-1 increase the possibility of CP [5], we may conclude that signs of decreased MPD compliance on MRCP-S may detect patients with early CP.
Main...
Personal information and conflict of interest
A. Vicic; Ljubljana/SI - nothing to disclose P. Popovic; Ljubljana/SI - nothing to disclose M. Garbajs; Ljubljana/SI - nothing to disclose
References
1.Frøkjær, Jens Brøndum, et al. "Guidelines for the diagnostic cross sectional imaging and severity scoring of chronic pancreatitis." Pancreatology 18.7 (2018): 764-773.
2.Chouhan, Manil D., et al. "Quantitative pancreatic MRI: a pathology-based review." The British journal of radiology 92.(2019): 20180941.
3.Schneider, Alexander, J. Matthias Löhr, and Manfred V. Singer. "The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease." Journal of gastroenterology 42.2 (2007): 101-119.
4.Matos, Celso, et al. "Pancreatic duct: morphologic and...