Skip to main content
SpringerLink
Log in

The utility of secretin-enhanced MRCP in diagnosing congenital anomalies

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

To assess the additional value of secretin-enhanced MRCP (SMRCP) over conventional MRCP in diagnosing divisum.

Methods

Retrospective HIPAA-compliant and IRB-approved review found 140 patients with SMRCP and ERCP correlation within 6 months of each other. All studies were anonymized and the SMRCP images (SMRCP image set) were separated from 2D and 3D MRCP and axial and coronal T2-weighted images (conventional MRI image set). Each image set on each patient was assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete divisum vs. incomplete divisum, and the certainty of diagnosis (1 = definitely certain, 2 = moderately certain, and 3 = unsure). ERCP findings were taken as gold standard.

Results

There was no difference in age and gender between the divisum (n = 97, with 13 incomplete divisum) and no divisum (n = 43) groups. In diagnosing divisum anatomy, the sensitivity was higher for SMRCP compared to conventional MRI for R1 (84.5 vs. 72.2, p = 0.02) but not R2 (89.7 vs. 84.4, p = 0.25). The specificity was higher in SMRCP image set compared to conventional MRI (R1: 88.1 vs. 76.2, p = 0.01; R2: 81.4 vs. 65.1, p < 0.001). The mean area under ROC curve was higher for SMRCP image set (R1: 0.86 vs. 0.74, p = 0.01; R2: 0.87 vs. 0.74, p = 0.01). The certainty of diagnosis was higher in SMRCP image set compared to conventional MRI (p = 0.02 for both reviewers). SMRCP was not found to be superior in distinguishing incomplete from complete divisum. The main reasons for erroneous SMRCP diagnosis were the presence of an ansa loop in the main duct and ductal strictures due to chronic pancreatitis.

Conclusion

Even though the reviewers had more sequences (axial and coronal) to evaluate in the non-secretin image set, there was some improvement in diagnosing divisum with SMRCP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Fischer M, Hassan A, Sipe BW, et al. (2010) Endoscopic retrograde cholangiopancreatography and manometry findings in 1,241 idiopathic pancreatitis patients. Pancreatology 10(4):444–452

    Article  PubMed  Google Scholar 

  2. Takuma K, Kamisawa T, Tabata T, Egawa N, Igarashi Y (2010) Pancreatic diseases associated with pancreas divisum. Dig Surg 27(2):144–148

    Article  PubMed  Google Scholar 

  3. Gonoi W, Akai H, Hagiwara K, et al. (2011) Pancreas divisum as a predisposing factor for chronic and recurrent idiopathic pancreatitis: initial in vivo survey. Gut 60(8):1103–1108

    Article  PubMed  Google Scholar 

  4. Cotton PB (1980) Congenital anomaly of pancreas divisum as cause of obstructive pain and pancreatitis. Gut 21(2):105–114

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Gregg JA (1977) Pancreas divisum: its association with pancreatitis. Am J Surg 134(5):539–543.

    Article  PubMed  CAS  Google Scholar 

  6. Satterfield ST, McCarthy JH, Geenen JE, et al. (1988) Clinical experience in 82 patients with pancreas divisum: preliminary results of manometry and endoscopic therapy. Pancreas 3(3):248–253.

    Article  PubMed  CAS  Google Scholar 

  7. Bertin C, Pelletier AL, Vullierme MP, et al. (2012) Pancreas divisum is not a cause of pancreatitis by itself but acts as a partner of genetic mutations. Am J Gastroenterol 107(2):311–317.

    Article  PubMed  CAS  Google Scholar 

  8. Cavestro GM, Zuppardo RA, Bertolini S, et al. (2010) Connections between genetics and clinical data: Role of MCP-1, CFTR, and SPINK-1 in the setting of acute, acute recurrent, and chronic pancreatitis. Am J Gastroenterol 105(1):199–206

    Article  PubMed  Google Scholar 

  9. Garg PK, Khajuria R, Kabra M, Shastri SS (2009) Association of SPINK1 gene mutation and CFTR gene polymorphisms in patients with pancreas divisum presenting with idiopathic pancreatitis. J Clin Gastroenterol 43(9):848–852.

    Article  PubMed  CAS  Google Scholar 

  10. Whitcomb DC (2012) Genetics of alcoholic and nonalcoholic pancreatitis. Curr Opin Gastroenterol. 28(5):501–506

    Article  PubMed  Google Scholar 

  11. Jacob L, Geenen JE, Catalano MF, et al. (1999) Clinical presentation and short-term outcome of endoscopic therapy of patients with symptomatic incomplete pancreas divisum. Gastrointest Endosc 49(1):53–57

    Article  PubMed  CAS  Google Scholar 

  12. Lehman GA, Sherman S (1998) Diagnosis and therapy of pancreas divisum. Gastrointest Endosc Clin N Am 8(1):55–77

    PubMed  CAS  Google Scholar 

  13. Kim MH, Lee SS, Kim CD, et al. (2001) Incomplete pancreas divisum: is it merely a normal anatomic variant without clinical implications? Endoscopy 33(9):778–785

    Article  PubMed  CAS  Google Scholar 

  14. Kamisawa T, Tu Y, Egawa N, Tsuruta K, Okamoto A (2006) Clinical implications of incomplete pancreas divisum. JOP 7(6):625–630

    PubMed  Google Scholar 

  15. Chey WY, Chang TM (2003) Secretin, 100 years later. J Gastroenterol 38(11):1025–1035.

    Article  PubMed  CAS  Google Scholar 

  16. Devereaux BM, Fein S, Purich E, et al. (2003) A new synthetic porcine secretin for facilitation of cannulation of the dorsal pancreatic duct at ERCP in patients with pancreas divisum: a multicenter, randomized, double-blind comparative study. Gastrointest Endosc 57(6):643–647

    Article  PubMed  Google Scholar 

  17. Devereaux BM, Lehman GA, Fein S, et al. (2002) Facilitation of pancreatic duct cannulation using a new synthetic porcine secretin. Am J Gastroenterol 97(9):2279–2281

    Article  PubMed  CAS  Google Scholar 

  18. Jowell PS, Branch MS, Fein SH, et al. (2011) Intravenous synthetic secretin reduces the incidence of pancreatitis induced by endoscopic retrograde cholangiopancreatography. Pancreas 40(4):533–539

    Article  PubMed  Google Scholar 

  19. Nicaise N, Pellet O, Metens T, et al. (1998) Magnetic resonance cholangiopancreatography: interest of IV secretin administration in the evaluation of pancreatic ducts. Eur Radiol 8(1):16–22

    Article  PubMed  CAS  Google Scholar 

  20. Manfredi R, Costamagna G, Brizi MG, et al. (2000) Pancreas divisum and “santorinicele”: diagnosis with dynamic MR cholangiopancreatography with secretin stimulation. Radiology 217(2):403–408

    Article  PubMed  CAS  Google Scholar 

  21. Song MH, Kim MH, Lee SK, Seo DW (2002) The clinical usefulness of secretin-enhanced magnetic resonance pancreatography in patients with pancreas divisum and idiopathic acute pancreatitis. Gastrointest Endosc 55(3):454–455

    Article  PubMed  Google Scholar 

  22. Hellerhoff KJ, Helmberger H 3rd, Rosch T, et al. (2002) Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracy. Am J Roentgenol 179(1):121–129

    Article  Google Scholar 

  23. Matos C, Metens T, Deviere J, et al. (2001) Pancreas divisum: evaluation with secretin-enhanced magnetic resonance cholangiopancreatography. GastrointestEndosc 53(7):728–733

    CAS  Google Scholar 

  24. Mosler P, Akisik F, Sandrasegaran K, et al. (2012) Accuracy of magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum. Dig Dis Sci 57(1):170–174

    Article  PubMed  Google Scholar 

  25. Carnes ML, Romagnuolo J, Cotton PB (2008) Miss rate of pancreas divisum by magnetic resonance cholangiopancreatography in clinical practice. Pancreas 37(2):151–153

    Article  PubMed  Google Scholar 

  26. Tirkes T, Akisik F, Tann M, Balci NC (2009) Imaging of the pancreas with secretin enhancement. Top Magn Reson Imaging 20(1):19–24

    Article  PubMed  Google Scholar 

  27. Akisik MF, Sandrasegaran K, Aisen AA, et al. (2006) Dynamic secretin-enhanced MR cholangiopancreatography. Radiographics 26(3):665–677

    Article  PubMed  Google Scholar 

  28. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428

    Article  PubMed  CAS  Google Scholar 

  29. Delhaye M, Cremer M (1992) Clinical significance of pancreas divisum. Acta Gastroenterol Belg 55(3):306–313

    PubMed  CAS  Google Scholar 

  30. Moffatt DC, Cote GA, Avula H, et al. (2011) Risk factors for ERCP-related complications in patients with pancreas divisum: a retrospective study. Gastrointest Endosc 73(5):963–970.

    Article  PubMed  Google Scholar 

  31. Kamisawa T, Egawa N, Tu Y, Tsuruta K, Okamoto A (2007) Pancreatographic investigation of embryology of complete and incomplete pancreas divisum. Pancreas 34(1):96–102.

    PubMed  Google Scholar 

  32. Liao Z, Gao R, Wang W, et al. (2009) A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum. Endoscopy 41(5):439–444

    Article  PubMed  CAS  Google Scholar 

  33. Bret PM, Reinhold C, Taourel P, et al. (1996) Pancreas divisum: evaluation with MR cholangiopancreatography. Radiology 199(1):99–103

    Article  PubMed  CAS  Google Scholar 

  34. Kamisawa T, Tu Y, Egawa N, et al. (2007) MRCP of congenital pancreaticobiliary malformation. Abdom Imaging 32(1):129–133

    Article  PubMed  CAS  Google Scholar 

  35. Koshinaga T, Fukuzawa M (2000) Pancreatic ductal morphological pattern and dilatation in postoperative abdominal pain in patients with congenital choledochal cyst: an analysis of postoperative pancreatograms. Scand J Gastroenterol 35(12):1324–1329

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA

    Kumaresan Sandrasegaran, Bilal Tahir, Iftikhar Ahmad, Mark Tann & Fatih M. Akisik

  2. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Gregory A. Cote & Stuart Sherman

  3. Department of Radiology, University of California, Irvine, CA, USA

    Chandana G. Lall

Authors
  1. Kumaresan Sandrasegaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory A. Cote
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bilal Tahir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Iftikhar Ahmad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Tann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fatih M. Akisik
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chandana G. Lall
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stuart Sherman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kumaresan Sandrasegaran.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sandrasegaran, K., Cote, G.A., Tahir, B. et al. The utility of secretin-enhanced MRCP in diagnosing congenital anomalies. Abdom Imaging 39, 979–987 (2014). https://doi.org/10.1007/s00261-014-0131-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-014-0131-z

Keywords

Search

Navigation