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European Radiology

, Volume 24, Issue 12, pp 3134–3141 | Cite as

Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?

  • Andrei S. Purysko
  • Namita S. Gandhi
  • R. Mathew Walsh
  • Nancy A. Obuchowski
  • Joseph C. Veniero
Hepatobiliary-Pancreas

Abstract

Objectives

To assess the value of secretin during magnetic resonance cholangiopancreatography (MRCP) in demonstrating communication between cystic lesions and the pancreatic duct to help determine the diagnosis of side-branch intraductal papillary mucinous neoplasm (SB-IPMN).

Methods

This is an IRB-approved, HIPAA-compliant retrospective study of 29 SB-IPMN patients and 13 non-IPMN subjects (control) who underwent secretin-enhanced MRCP (s-MRCP). Two readers blinded to the final diagnosis reviewed three randomised image sets: (1) pre-secretin HASTE, (2) dynamic s-MRCP and (3) post-secretin HASTE. Logistic regression, generalised linear models and ROC analyses were used to compare pre- and post-secretin results.

Results

There was no significant difference in median scores for the pre-secretin [reader 1: 1; reader 2: 2 (range -2 to 2)] and post-secretin HASTE [reader 1: 1; reader 2: 1 (range -2 to 2)] in the SB-IPMN group (P = 0.14), while the scores were lower for s-MRCP [reader 1: 0.5 (range -2 to 2); reader 2: 0 (range -1 to 2); P = 0.016]. There was no significant difference in mean maximum diameter of SB-IPMN on pre- and post-secretin HASTE, and s-MRCP (P > 0.05).

Conclusion

Secretin stimulation did not add to MRCP in characterising pancreatic cystic lesions as SB-IPMN.

Key Points

Magnetic resonance cholangiopancreatography (MRCP) is used to evaluate pancreatic cystic lesions.

Intraductal papillary mucinous neoplasm (IPMN) is a type of pancreatic cystic neoplasm.

Secretin administration does not facilitate the diagnosis of IPMN on MRCP.

Keywords

Magnetic resonance imaging Secretin Pancreatic neoplasms Intraductal papillary mucinous neoplasm Pancreatic cyst 

Abbreviations

MRCP

magnetic resonance cholangiopancreatography

S-MRCP

secretin-enhanced magnetic cholangiopancreatography

IPMN

intraductal papillary mucinous neoplasm, SB-IPMN, side-branch intraductal papillary mucinous neoplasm

MDCT

multidetector computed tomography

HASTE

half-Fourier acquisition single-shot turbo spin-echo

MPD

main pancreatic duct

Notes

Acknowledgments

The scientific guarantor of this publication is Namita S. Gandhi, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic, performed at one institution

References

  1. 1.
    Rickaert F, Cremer M, Devière J et al (1991) Intraductal mucin-hypersecreting neoplasms of the pancreas. A clinicopathologic study of eight patients. Gastroenterology 101:512–519PubMedGoogle Scholar
  2. 2.
    Kloppel G, Solcia E, Longnecker DS, Capella C, Sobin LH (1996) Histological typing of tumours of the exocrine pancreas. In: World Health Organization International Histological Classification of Tumors, 2nd edn. Springer, Berlin, pp 11–20Google Scholar
  3. 3.
    Adsay NV (2007) Cystic lesions of the pancreas. Mod Pathol 20:S71–S93CrossRefGoogle Scholar
  4. 4.
    Tanaka M, Fernández-del Castillo C, Adsay V et al (2012) International Association of Pancreatology. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197PubMedCrossRefGoogle Scholar
  5. 5.
    Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773PubMedCrossRefGoogle Scholar
  6. 6.
    Guarise A, Faccioli N, Ferrari M et al (2008) Evaluation of serial changes of pancreatic branch duct intraductal papillary mucinous neoplasms by follow-up with magnetic resonance imaging. Cancer Imaging 8:220–228PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Lim JH, Lee G, Oh YL (2001) Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21:323–337PubMedCrossRefGoogle Scholar
  8. 8.
    Pedrosa I, Boparai D (2010) Imaging considerations in intraductal papillary mucinous neoplasms of the pancreas. World J Gastrointest Surg 2:324–330PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR (2009) MR imaging of cystic lesions of the pancreas. Radiographics 29:1749–1765PubMedCrossRefGoogle Scholar
  10. 10.
    Waters JA, Schmidt CM, Pinchot JW et al (2008) CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 12:101–109PubMedCrossRefGoogle Scholar
  11. 11.
    Manfredi R, Graziani R, Motton M et al (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253:106–115PubMedCrossRefGoogle Scholar
  12. 12.
    Carbognin G, Pinali L, Girardi V, Casarin A, Mansueto G, Mucelli RP (2007) Collateral branches IPMTs: secretin-enhanced MRCP. Abdom Imaging 32:374–380PubMedCrossRefGoogle Scholar
  13. 13.
    Chey WY, Chang TM (2003) Secretin, 100 years later. J Gastroenterol 38:1025–1035PubMedCrossRefGoogle Scholar
  14. 14.
    Sanyal R, Stevens T, Novak E, Veniero JC (2012) Secretin-enhanced MRCP: review of technique and application with proposal for quantification of exocrine function. AJR Am J Roentgenol 198:124–132PubMedCrossRefGoogle Scholar
  15. 15.
    Tirkes T, Sandrasegaran K, Sanyal R et al (2013) Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics 33:1889–1906PubMedCrossRefGoogle Scholar
  16. 16.
    Matos C, Metens T, Deviere J et al (1997) Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 203:435–441PubMedCrossRefGoogle Scholar
  17. 17.
    Hellerhoff KJ, Helmberger H 3rd, Rösch T, Settles MR, Link TM, Rummeny EJ (2002) Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracy. AJR Am J Roentgenol 179:121–129PubMedCrossRefGoogle Scholar
  18. 18.
    Fukukura Y, Fujiyoshi F, Sasaki M, Nakajo M (2002) Pancreatic duct: morphologic evaluation with MR cholangiopancreatography after secretin stimulation. Radiology 222:674–680PubMedCrossRefGoogle Scholar
  19. 19.
    Fernádez-del Castillo C, Adsay NV (2010) Intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 139:708–713CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Andrei S. Purysko
    • 1
  • Namita S. Gandhi
    • 1
  • R. Mathew Walsh
    • 2
  • Nancy A. Obuchowski
    • 3
  • Joseph C. Veniero
    • 1
  1. 1.From the Abdominal Imaging Section, Imaging InstituteCleveland ClinicClevelandUSA
  2. 2.Department of General Surgery, Digestive Disease InstituteCleveland ClinicClevelandUSA
  3. 3.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA

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