Secretin-stimulated MR cholangio-pancreatography in the evaluation of asymptomatic patients with non-specific pancreatic hyperenzymemia

Abstract

Purpose: To assess the diagnostic value of secretin-stimulated MRCP (SS-MRCP) compared with conventional MRCP in asymptomatic patients with mild elevations of pancreatic enzymes.

Materials and methods: Eighty asymptomatic patients with pancreatic hyperenzymemia underwent MR imaging at 1.5T-device (Signa EXCITE, GE Healthcare). After the acquisition of axial T1w,T2w sequences, and conventional MRCP, SS-MRCP was performed using a single-slice coronal breath-hold, thick-slab, SSFSE T2w sequence, repeated every 30s up to 15 min following intravenous injection of secretin (Secrelux, Sanochemia).

Results: On the basis of the standards of reference, our final diagnoses were: negative findings (n=23), pancreas divisum (n=22), mild chronic pancreatitis (n=14), inflammatory ampullary stenosis (n=3), juxtapapillary duodenal diverticulum (n=1), small cystic lesions (<1cm) (n=22; 5/22 cases associated with pancreas divisum). The image quality of SS-MRCP was significantly higher than that of conventional MRCP (p<0.0001). Standards of reference did not differ significantly from of SS-MRCP findings (p=0.5), while was statistically different from those of conventional MRCP (p<0.0001). A significant difference was found between conventional MRCP and SS-MRCP findings (p<0.0001).

Conclusion: In asymptomatic patients with non-specific pancreatic hyperenzymemia SS-MRCP may represent the best non-invasive diagnostic technique, since it gives morphological and functional information.