About 252 patient, 172 subjects (68%) had an abnormal increase of lipase and amylase, 57 (22%) of amylase and 23 (9%) of lipase.
76% of the studied patients had had different pancreatic anomalies at s-MRCP.
MRI signs of chronic pancreatitis were detected in 168 (65,7%) subjects, of whom 108 were mild and 60 moderate according to the Cambridge classification (Fig. 1) [11].
Secondary, sphincter of Oddi dysfunction (SOD) was founded in 80 patients (31,7%); this is a term used to indicate abnormal motility of the Sphincter of Oddi. For this condition, a definitive diagnosis requires demonstration of elevated SO baseline pressure (> 40 mmHg) at endoscopic manometry. However, today the S-MRCP has replaced diagnostic ERCP in the clinical practice [12], thanks to the demonstration of a persistent dilatation of the MPD for more than 10-15 minutes after the e.v. secretin injection (Fig. 2) [13].
The “acinar filling” was observed in 24 subjects (9,5%); it is an MRI sign characterized by a progressive hydrographic enhancement of the pancreatic parenchyma after the secretin stimulation (Fig. 3) [14]. In this class, more than 90% of the patients showed signs of chronic pancreatitis.
Another MRI finding was the evidence of “pancreas divisum”, founded in 24 patients (9,5%); it is characterized by the presence of a dorsal pancreatic duct (made of main pancreatic and Santorini ducts) directly entering to the minor papilla without communication with the ventral duct (Wirsung), direct to the major papilla (Fig. 4).
We studied also the functional capacity of the exocrine pancreas after e.v. secretin injection, according to the Matos classification. Concurring to the literature data [15], the pancreatic exocrine function is reduced when the duodenal filling is lower than grade 3. It was normal in 96,7%; particularly, we founded 9 cases with grade two (Fig. 5) and 1 with grade one.
Cysts < 5 mm and > 5 mm were identified in 10 (4%) and 14 (5,5%) subjects respectively; moreover, 14 patients needed a follow-up for brunch-duct IPMN.