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 the patients developed neither clinical neither laboratory signs of acute pancreatitis.
FE-1 GROUPS
Median levels of FE-1 and number of patients in three different groups of patients according to FE-1 level were as follows: 323 µg/g (range 270 – 593 µg/g) in group 1 (9 patients [23.5%]), 178 µg/g (range 170 – 198 µg/g) in group 2 (3 patients [17.6%]) and 54 µg/g in group 3 (1 patient [5.9%]).
ANALYSIS OF THE GRADE OF DUODENAL FILLING AND SIGNS OF MAIN PANCREATIC DUCT COMPLIANCE
1 patient (5.9%) had grade 3 duodenal filling, 4 patients (23.5%) had grade 2 duodenal filling (Figure 1) and the remaining 11 patients (64.7%) had grade 1 duodenal filling (Figure 2). None of the patients with clinically suspected early PEI showed diminished exocrine function on MRCP-S.
The analysis of all patients for the signs of MPD compliance showed that median value of maximal duct dilatation after secretin was 2.06 mm (range, 0 – 7 mm) with median timing of maximal dilatation after secretin application 2 min (range, 1 – 4 min). Median time of duct returning to normal in all patients was after 3.7 min (range, 3-7 min).
Overall, 4 of 17 (23.6%) patients showed indirect signs od decreased MPD compliance: 2 of 17 (11.8%) patients showed no dilatation of MPD, 1 patient (5.9%) showed only minimal dilatation (1 mm) (Figure 2) and the remaining 1 patient (5. 9%) showed delayed returning (after 7 min) of MPD to normal after secretin application. In addition, all these four patients showed diminished duodenal filling after secretin. Clinically, 3 of these 4 patients were healthy controls with no suspicion of early CP and 1 patient had previously been treated for CP with enzyme substitution therapy.
CORRELATION ANALYSIS
A borderline negative significant correlation was found between the degree of main pancreatic duct dilatation after secretin application and FE-1 groups (p = 0.079, r = -0.533).
On the contrary, no correlation was found between duodenal filling and FE-1 groups (p = 0.696) as well as to other imaging parameters.