Advertisement

European Radiology

, Volume 15, Issue 10, pp 2110–2121 | Cite as

Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitis. Initial results

  • M. A. BaliEmail author
  • A. Sztantics
  • T. Metens
  • M. Arvanitakis
  • M. Delhaye
  • J. Devière
  • C. Matos
Hepatobiliary-Pancreas

Abstract

The aim of this study was to quantify pancreatic exocrine function in normal subjects and in patients with chronic pancreatitis (CP) before and after pancreatic duct drainage procedures (PDDP) with dynamic secretin-enhanced magnetic resonance (MR) cholangiopancreatography (S-MRCP). Pancreatic exocrine secretions [quantified by pancreatic flow output (PFO) and total excreted volume (TEV)] were quantified twice in ten healthy volunteers and before and after treatment in 20 CP patients (18 classified as severe, one as moderate, and one as mild according to the Cambridge classification). PFO and TEV were derived from a linear regression between MR-calculated volumes and time. In all subjects, pancreatic exocrine fluid volume initially increased linearly with time during secretin stimulation. In controls, the mean PFO and TEV were 6.8 ml/min and 97 ml; intra-individual deviations were 0.8 ml/min and 16 ml. In 10/20 patients with impaired exocrine secretions before treatment, a significant increase of PFO and TEV was observed after treatment (P<0.05); 3/20 patients presented post-procedural acute pancreatitis and a reduced PFO. The S-MRCP quantification method used in the present study is reproducible and provides normal values for PFO and TEV in the range of those obtained from previous published intubation studies. The initial results in CP patients have demonstrated non-invasively a significant short-term improvement of PFO and TEV after PDDP.

Keywords

MR cholangiopancreatography MR quantification Chronic pancreatitis 

References

  1. 1.
    Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification and new genetic developments. Gastroenterology 120:682–707PubMedGoogle Scholar
  2. 2.
    Karanjia ND, Singh SM, Widdison AL, Lutrin FS, Reber HA (1992) Pancreatic duct and interstitial pressures in cats with chronic pancreatitis. Dig Dis Sci 37:268–273CrossRefPubMedGoogle Scholar
  3. 3.
    Glasbrenner B, Kahl S, Malfertheiner P (2002) Modern diagnostics of chronic pancreatitis. Eur J Gastroenterol Hepatol 14:935–941CrossRefPubMedGoogle Scholar
  4. 4.
    Delhaye M, Matos C, Devière J (2003) Endoscopic management of chronic pancreatitis. Gastrointest Endoscopy Clin N Am 13:717–742CrossRefGoogle Scholar
  5. 5.
    Rosch T, Daniel S, Scholz M, Huibregtse K, Smits M, Schneider T, Ell C, Haber G, Riemann JF, Jacobs R, Hintze R, Adler A, Neuhau H, Zavoral M, Zavada F, Schusdziarra V, Soehendra N (2002) Endoscopic treatment of chronic pancreatitis: a multicenter study of 1000 patients with long-term follow-up. Endoscopy 34:765–771CrossRefPubMedGoogle Scholar
  6. 6.
    Laugier R (1994) Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis. Endoscopy 26:222–227PubMedGoogle Scholar
  7. 7.
    Delhaye M, Vandermeeren A, Baize M, Cremer M (1992) Extracorporeal shock-wave lithotripsy of pancreatic calculi. Gastroenterology 102:610–620PubMedGoogle Scholar
  8. 8.
    Deviere J, Urbain P, Cremer M (1987) Reversibility of exocrine pancreatic function. Gastroenterology 92:2053–2054Google Scholar
  9. 9.
    Malfertheiner P, Büchler M (1989) Correlation of imaging and function in chronic pancreatitis. Radiol Clin North Am 27:51–64PubMedGoogle Scholar
  10. 10.
    Robberecht P, Cremer M, Vandermeers A, Vandermeers-Piret MC, Cotton P, De Neef P, Cristophe J (1975) Pancreatic secretion of total protein and of three hydrolases collected in healthy subjects via duodenoscopic cannulation. Gastroenterology 69:374–379PubMedGoogle Scholar
  11. 11.
    Matos C, Metens T, Devière J, Nicaise N, Braude P, Van Yperen G, Cremer M, Struyven J (1997) Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 203:435–441PubMedGoogle Scholar
  12. 12.
    Cappeliez O, Delhaye M, Devière J, Lemoine O, Metens T, Nicaise N, Cremer M, Struyven J, Matos C (2000) Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology 215:358–364PubMedGoogle Scholar
  13. 13.
    Sica GT, Braver J, Cooney MJ, Miller FH, Chai JL, Adams DF (1999) Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 210:605–610PubMedGoogle Scholar
  14. 14.
    Manfredi R, Costamagna G, Brizi MG, Maresca V, Vecchioli A, Colagrande C, Marano P (2000) Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 214:849–855PubMedGoogle Scholar
  15. 15.
    Heverhagen JT, Muller D, Battmann A, Ishaque N, Boehm D, Katschinski M, Wagner HJ, Klose KJ (2001) MR hydrometry to assess exocrine function of the pancreas: initial results of noninvasive quantification of secretion. Radiology 218:61–67PubMedGoogle Scholar
  16. 16.
    Punwani S, Gillams AR, Lees WR (2003) Non-invasive quantification of pancreatic exocrine function using secretin-stimulated MRCP. Eur Radiol 13:273–276PubMedGoogle Scholar
  17. 17.
    Heverhagen JT, Battmann A, Kirsch M, Boehm D, Eissele R, Klose KJ, Wagner HJ (2002) Magnetic resonance hydrometry: non-invasive quantification of the exocrine pancreatic function. Fortschr Röntgenstr 174:291–296CrossRefGoogle Scholar
  18. 18.
    Axon AT, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR (1984) Pancreatography in chronic pancreatitis: international definitions. Gut 25:1107–1112PubMedGoogle Scholar
  19. 19.
    Ammann RW, Muellhaupt B (1999) The natural history of pain in chronic pancreatitis. Gastroenterology 116:1132–1140PubMedGoogle Scholar
  20. 20.
    Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P (1999) SENSE: sensitivity encoding for fast MRI. Magn Reson Med 42:952–962PubMedGoogle Scholar
  21. 21.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310PubMedGoogle Scholar
  22. 22.
    Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, Jeanmart J, Zalcman M, Van Gansbeke D, Devière J, Matos C (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 126:715–723CrossRefPubMedGoogle Scholar
  23. 23.
    Devière J, Gulbis B, Delhaye M, Quenon M, Cremer M (1985) Relation entre la morphologie canalaire et la fonction exocrine du pancréas: une méthode originale d’estimation linéaire de la fonction pancréatique. Acta Endoscopica 15:403–414Google Scholar
  24. 24.
    Bozkurt T, Braun U, Leferink S, Gilly G, Lux G (1984) Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis. Gut 35:1132–1136Google Scholar
  25. 25.
    Andrén-Sandberg A, Hoem D, Gislason H (2002) Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol 14:957–970CrossRefPubMedGoogle Scholar
  26. 26.
    Ohara H, Hoshino M, Hayakawa T, Kamiya Y, Miyaji M, Takeuchi T, Okayama Y (1996) Single application of extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic stones. Am J Gastroenterol 91:1388–1392PubMedGoogle Scholar
  27. 27.
    Delhaye M, Arvanitakis M, Verset G, Cremer M, Devière J (2004) Long-term clinical outcome after endoscopic pancreatic ductal drainage for patients with painful chronic pancreatitis. Clinical Gastroenterol Hepatol 2:1096–1106CrossRefGoogle Scholar
  28. 28.
    O’Keefe SDJ, Byrd-Lee R, Abou-Assi S (2002) Acute pancreatitis reduces pancreatic enzyme secretion but not synthesis in human. Gut 51(Suppl III):A62Google Scholar
  29. 29.
    Niederau C, Niederau M, Lüthen R, Strohmeyer G, Ferrell LD, Grendell JH (1990) Pancreatic exocrine secretion in acute experimental pancreatitis. Gastroenterology 99:1120–1127PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • M. A. Bali
    • 1
    Email author
  • A. Sztantics
    • 1
  • T. Metens
    • 1
  • M. Arvanitakis
    • 2
  • M. Delhaye
    • 2
  • J. Devière
    • 2
  • C. Matos
    • 1
  1. 1.Department of Radiology, Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Department of Gastroenterology, Hôpital ErasmeUniversité Libre de BruxellesBrusselsBelgium

Personalised recommendations