Journal of Gastroenterology

, Volume 42, Supplement 17, pp 113–117 | Cite as

Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography

  • László Czakó


A diagnostic means of detecting chronic pancreatitis at an early stage, when the disease is still reversible, needs to be developed. Magnetic resonance cholangiopancreatography (MRCP) has recently been evolving as an important tool for the evaluation of chronic pancreatitis. In patients with moderate chronic pancreatitis, the pancreatic parenchyma displays an abnormal enhancement pattern on T1-weighted sequences after gadolinium administration. The presence of a signal intensity ratio of <1.7 in the arterial phase and/or delayed peak enhancement after contrast administration has a sensitivity of 92% and a specificity of 75% for the demonstration of early chronic pancreatitis. The secretin-induced pancreatic T2 signal intensity changes are significantly reduced in patients with a mild exocrine pancreatic insufficiency as compared with healthy volunteers. MRCP visualizes fluid in the pancreatic and biliary ducts as high signal intensity on heavily T2-weighted sequences. However, visualization of normal or minimally dilated pancreatic ducts by MRCP is more challenging because of their small size. Secretin administration stimulates fluid and bicarbonate secretion by the exocrine pancreas; consequently, it improves the pancreatic duct and side-branch delineation and allows an evaluation of the exocrine pancreatic function. Side-branch ectasia, mild ductal dilatation with loss of the normal gentle taper, and mural irregularities are the pathognomonic MRCP features of early-stage chronic pancreatitis. Through measurement of the duodenal filling, secretin-MRCP allows quantitative assessment of the exocrine pancreatic function, even in patients with a mild exocrine insufficiency. The morphology of the pancreatic ducts, particularly in the early stages, does not always correlate with the functional status. MRCP permits visualization of the ductal changes and furnishes functional information on the pancreas; this combination may enhance its diagnostic accuracy so that MRCP can become a valuable diagnostic means in early-stage chronic pancreatitis.

Key words

magnetic resonance cholangiopancreatography secretin early-stage chronic pancreatitis exocrine pancreatic insufficiency Lundh test 


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  1. 1.
    Otsuki, M 2004Chronic pancreatitis. The problems of diagnostic criteriaPancreatology42841PubMedCrossRefGoogle Scholar
  2. 2.
    Etemad, B, Whitcomb, DC 2001Chronic pancreatitis: diagnosis, classification, and new genetic developmentsGastroenterology120682707PubMedCrossRefGoogle Scholar
  3. 3.
    Steer, ML, Waxman, I, Freedman, S 1995Chronic pancreatitisN Eng J Med332148290CrossRefGoogle Scholar
  4. 4.
    Kahl, S, Glasbrenner, B, Leodolter, A, Pross, M, Schulz, HU, Malfertheiner, P 2002EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up studyGastrointest Endosc5550711PubMedCrossRefGoogle Scholar
  5. 5.
    Wallace, MB, Hawes, RH 2001Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitisPancreas232635PubMedCrossRefGoogle Scholar
  6. 6.
    Tamura, R, Ishibashi, T, Takahashi, S 2006Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluationRadiology2389208PubMedGoogle Scholar
  7. 7.
    Coakley, FV, Schwartz, LH 1999Magnetic resonance cholangiopancreatographyJ Magn Reson Imaging915762PubMedCrossRefGoogle Scholar
  8. 8.
    Takehara, Y 1998Can MRCP replace ERCP?J Magn Reson Imaging851734PubMedGoogle Scholar
  9. 9.
    Villalba-Martin, C, Dominquez-Munoz, E 2005Role of imaging methods in diagnosing, staging and detecting complications of chronic pancreatitis in clinical practice: should MRCP and MRI replace ERCP and CT?Dominquez-Munoz, E eds. Clinical pancreatology1st edBlackwellOxford23645Google Scholar
  10. 10.
    Keppke, AL, Miller, FH 2005Magnetic resonance imaging of the pancreas: the future is nowSemin Ultrasound CT MR2613252PubMedCrossRefGoogle Scholar
  11. 11.
    Pamuklar, E, Semelka, RC 2005MR imaging of the pancreasMagn Reson Imaging Clin N Am1331330PubMedCrossRefGoogle Scholar
  12. 12.
    Xm, Zhang, Shi, H, Parker, L, Dohke, M, Holland, GA, Mitchell, DG 2003Suspected early or mild chronic pancreatitis: enhancement patterns on gadolinium chelate dynamic MRIJ Magn Reson Imaging178694CrossRefGoogle Scholar
  13. 13.
    Czakó, L, Endes, J, Takács, T, Boda, K, Lonovics, J 2001Evaluation of pancreatic exocrine function by means of secretin-enhanced MR cholangiopancreatographyPancreas233238PubMedCrossRefGoogle Scholar
  14. 14.
    Hellerhoff, KJ, Helmberger, H,3rd, Rosch, T, Settles, MR, Link, TM, Rummeny, EJ 2002Dynamic MR pancreatography after secretin administration: image quality and diagnostic accuracyAJR Am J Roentgenol1791219PubMedGoogle Scholar
  15. 15.
    Manfredi, R, Costamagna, G, Brizi, MG, Maresca, G, Vecchioli, A, Colagrande, C,  et al. 2000Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulationRadiology21484955PubMedGoogle Scholar
  16. 16.
    Clain, JE, Pearson, RK 1999Diagnosis of chronic pancreatitis. Is a gold standard necessary?Surg Clin North Am7982945PubMedCrossRefGoogle Scholar
  17. 17.
    Lankisch, PG, Seidensticker, F, Otto, J, Lubbers, H, Mahlke, R, Stockmann, F,  et al. 1996Secretin-pancreozymin test (SPT) and endoscopic retrograde cholangiopancreatography (ERCP): both are necessary for diagnosing or excluding chronic pancreatitisPancreas1214952PubMedCrossRefGoogle Scholar
  18. 18.
    Malfertheiner, P, Büchler, M 1989Correlation of imaging and function in chronic pancreatitisRadiol Clin North Am275164PubMedGoogle Scholar
  19. 19.
    Cappeliez, O, Delhaye, M, Deviére, J, Le Moine, O, Metens, T, Nicaise, N,  et al. 2000Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulationRadiology21535864PubMedGoogle Scholar
  20. 20.
    Bali, MA, Sztantics, A, Metens, T, Arvanitakis, M, Delhaye, M, Deviére, J,  et al. 2005Quantification of pancreatic exocrine function with secretin-enhanced magnetic resonance cholangiopancreatography: normal values and short-term effects of pancreatic duct drainage procedures in chronic pancreatitisEur Radiol15211021PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2007

Authors and Affiliations

  • László Czakó
    • 1
  1. 1.First Department of MedicineUniversity of SzegedSzegedHungary

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