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Accuracy of a novel noninvasive secretin-enhanced MRCP severity index scoring system for diagnosis of chronic pancreatitis: correlation with EUS-based Rosemont criteria

  • ABDOMINAL RADIOLOGY
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Abstract

Purpose

To evaluate the accuracy of a secretin-enhanced MRCP Chronic Pancreatitis Severity Index (CPSI) in the diagnosis of chronic pancreatitis (CP) based on endoscopic ultrasound (EUS) Rosemont criteria.

Methods

In this retrospective study, 31 patients (20 women; median age 48 years, range 18–77) with known/suspected CP evaluated with both EUS and secretin-enhanced MRCP were included. CP severity was graded using a ten-point-scale secretin-enhanced MRCP-based CPSI scoring system which considered ductal, parenchymal and secretin-based dynamic abnormalities. Cases were categorized as normal, mild, moderate or severe CP. Correlation between CPSI and the EUS Rosemont criteria was performed using Cohen’s kappa coefficient. Comparative evaluation of test performance was obtained using ROC analysis.

Results

Using EUS Rosemont criteria, eight patients had features consistent/suggestive of CP, 20 patients were normal and three were indeterminate. On CPSI, five patients were normal, 12 had mild and 14 had moderate/severe CP. There was only fair agreement (k = 0.272) between CPSI and Rosemont criteria categories. CPSI showed 87.5% sensitivity, 69.6% specificity and 74.2% accuracy (cutoff value = 3.5 points; area under the curve = 0.804; p = 0.0026) for CP diagnosis based on EUS Rosemont criteria.

Conclusion

CPSI showed relatively high diagnostic accuracy for diagnosis of CP based on Rosemont criteria. The CPSI scoring system can be proposed as a noninvasive alternative to the EUS Rosemont criteria for CP diagnosis.

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References

  1. Braganza JM, Lee SH, McCloy RF, McMahon MJ (2011) Chronic pancreatitis. Lancet 377:1184–1197

    Article  CAS  PubMed  Google Scholar 

  2. Steer ML, Waxman I, Freedman S (1995) Chronic pancreatitis. N Engl J Med 332(22):1482–1490

    Article  CAS  PubMed  Google Scholar 

  3. Otsuki M (2007) Symposium 3. Chronic pancreatitis: current problems of the diagnostic criteria. J Gastroenterol 42(S17):52–54

    Article  PubMed  Google Scholar 

  4. Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120(3):682–707

    Article  CAS  PubMed  Google Scholar 

  5. Tirkes T, Sandrasegaran K, Sanyal R et al (2013) Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics 33(7):1889–1906

    Article  PubMed  Google Scholar 

  6. Catalano MF, Sahai A, Levy M et al (2009) EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 69(7):1251–1261

    Article  PubMed  Google Scholar 

  7. Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25(7):756–759

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hernandez LV, Catalano MF (2010) EUS in the diagnosis of early-stage chronic pancreatitis. Best Pract Res Clin Gastroenterol 24(3):243–249

    Article  PubMed  Google Scholar 

  9. Ito T, Ishiguro H, Ohara H et al (2016) Evidence-based clinical practice guidelines for chronic pancreatitis 2015. J Gastroenterol 51(2):85–92

    Article  CAS  PubMed  Google Scholar 

  10. Tirkes T, Shah ZK, Takahashi N et al (2019) Reporting standards for chronic pancreatitis by using CT, MRI, and MR cholangiopancreatography: the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Radiology 290(1):207–215

    Article  PubMed  Google Scholar 

  11. Fulcher AS, Turner MA (2002) MR cholangiopancreatography. Radiol Clin North Am 40(6):1363–1376

    Article  PubMed  Google Scholar 

  12. Pungpapong S, Wallace MB, Woodward TA et al (2007) Accuracy of endoscopic ultrasonography and magnetic resonance cholangiopancreatography for the diagnosis of chronic pancreatitis: a prospective comparison study. J Clin Gastroenterol 41(1):88–93

    Article  PubMed  Google Scholar 

  13. Balci NC, Smith A, Momtahen AJ et al (2010) MRI and S-MRCP findings in patients with suspected chronic pancreatitis: correlation with endoscopic pancreatic function testing (ePFT). J Magn Reson Imaging 31(3):601–606

    Article  PubMed  Google Scholar 

  14. Sainani NI, Kadiyala V, Mortele K et al (2015) Evaluation of qualitative magnetic resonance imaging features for diagnosis of chronic pancreatitis. Pancreas 44(8):1280–1289

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Issa Y, Kempeneers MA, van Santvoort HC et al (2017) Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis. Eur Radiol 27(9):3820–3844

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Tirkes T, Fogel EL, Sherman S et al (2017) Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis. Abdom Radiol 42(2):544–551

    Article  Google Scholar 

  18. Sherman S, Freeman ML, Tarnasky PR et al (2014) Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology 147(3):646–654

    Article  CAS  PubMed  Google Scholar 

  19. Zhang TT, Wang L, Wang DB et al (2013) Correlation between secretin-enhanced MRCP findings and histopathologic severity of chronic pancreatitis in a cat model. Pancreatology 13(5):491–497

    Article  PubMed  Google Scholar 

  20. Matos C, Metens T, Devière J et al (1997) Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 203(2):435–441

    Article  CAS  PubMed  Google Scholar 

  21. Conwell DL, Lee LS, Yadav D et al (2014) American Pancreatic Association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas 43(8):1143–1162

    Article  PubMed  PubMed Central  Google Scholar 

  22. Testoni PA, Mariani A, Curioni S et al (2009) Pancreatic ductal abnormalities documented by secretin-enhanced MRCP in asymptomatic subjects with chronic pancreatic hyperenzymemia. Am J Gastroenterol 104(7):1780–1786

    Article  PubMed  Google Scholar 

  23. Singh VK, Yadav D, Garg PK (2019) Diagnosis and management of chronic pancreatitis: a review. JAMA 322(24):2422–2434

    Article  CAS  PubMed  Google Scholar 

  24. Sai JK, Suyama M, Kubokawa Y et al (2008) Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World J Gastroenterol 14(8):1218–1221

    Article  PubMed  PubMed Central  Google Scholar 

  25. Alkaade S, Cem Balci N, Momtahen AJ et al (2008) Normal pancreatic exocrine function does not exclude MRI/MRCP chronic pancreatitis findings. J Clin Gastroenterol 42(8):950–955

    Article  PubMed  Google Scholar 

  26. Schneider A, Löhr JM, Singer MV (2007) The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 42:101–119

    Article  PubMed  Google Scholar 

  27. Manfredi R, Pozzi Mucelli R (2016) Secretin-enhanced MR imaging of the pancreas. Radiology 279(1):29–43

    Article  PubMed  Google Scholar 

  28. Manfredi R, Costamagna G, Brizi MG et al (2000) Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 214(3):849–855

    Article  CAS  PubMed  Google Scholar 

  29. Heuck A, Maubach PA, Reiser M et al (1987) Age-related morphology of the normal pancreas on computed tomography. Gastrointest Radiol 12(1):18–22

    Article  CAS  PubMed  Google Scholar 

  30. Ketwaroo G, Brown A, Young B et al (2013) Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis. Am J Gastroenterol 108(8):1360–1366

    Article  PubMed  PubMed Central  Google Scholar 

  31. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  PubMed  Google Scholar 

  32. Kalmin B, Hoffman B, Hawes R et al (2011) Conventional versus Rosemont endoscopic ultrasound criteria for chronic pancreatitis: comparing interobserver reliability and intertest agreement. Can J Gastroenterol 25(5):261–264

    Article  PubMed  PubMed Central  Google Scholar 

  33. Petrone MC, Terracciano F, Perri F et al (2014) Pancreatic abnormalities detected by endoscopic ultrasound (EUS) in patients without clinical signs of pancreatic disease: any difference between standard and Rosemont classification scoring? Pancreatology 14(3):227–230

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Author notes

  1. Gyanprakash A. Ketwaroo

    Present address: Department of Medicine, Division of Gastroenterology and Hepatology, Baylor College School of Medicine, 2002 Holcombe Blvd., Houston, TX, 77030, USA

Authors and Affiliations

  1. Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Francesco Alessandrino & Koenraad J. Mortele

  2. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Daniel Souza & Francesco Alessandrino

  3. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Gyanprakash A. Ketwaroo & Mandeep Sawhney

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  1. Daniel Souza
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Correspondence to Francesco Alessandrino.

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Conflict of interest

Daniel Souza, Francesco Alessandrino, Gyanprakash A. Ketwaroo, Mandeep Sawhney, Koenraad J. Mortele declare that they have no conflict of interest.

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Souza, D., Alessandrino, F., Ketwaroo, G.A. et al. Accuracy of a novel noninvasive secretin-enhanced MRCP severity index scoring system for diagnosis of chronic pancreatitis: correlation with EUS-based Rosemont criteria. Radiol med 125, 816–826 (2020). https://doi.org/10.1007/s11547-020-01181-3

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  • DOI: https://doi.org/10.1007/s11547-020-01181-3

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