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Functional MRCP in pancreatic and periampullary disease

  • Celso MatosEmail author
  • Catherine Winant
  • Myriam Delhaye
  • Jacques Devière
Review Article

Summary

Background. The magnetic resonance (MR) evaluation of the pancreatic and biliary tree has undergone an important evolution because the introduction of the technique of MR cholangiopancreatography (MRCP).

Aim. To describe and illustrate the technique of secretin-enhanced MRCP (S-MRCP) and discuss its use in pancreatic and periampullary disease.

Methods. Results are based on 6 years experience using MRCP with secretin infusion in hundreds of patients in a tertiary referral center.

Results. Secretin improves pancreatic duct and side-branch delineation and the detection of anatomic variants such as pancreas divisum and abnormal common bilio-pancreatic channel. It allows monitoring of pancreatic flow dynamics and evaluation of pancreatic exocrine function that has been previously unavailable. In advanced inflammatory disease, it is useful in monitoring the course of the disease, for planning therapy and for follow-up studies after therapeutic endoscopy.

Conclusion. Combining morphology and function into one non-invasive and comprehensive diagnostic modality has expanded the clinical applications of MRCP beyond the diagnostic ERCP that it replaces.

Key Words

Magnetic resonance cholangiopancreatography (MRCP) pancreas, MR pancreatic ducts, MR pancreas, function pancreatitis secretin 

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References

  1. 1.
    Bolondi L, Gaiani S, Gullo L, Labò G. Secretin administration induces a dilatation of the main pancreatic duct. Dig Dis Sci 1984;29:802–808.PubMedCrossRefGoogle Scholar
  2. 2.
    Glaser J, Hogemann B, Krummenerl T, et al. Sonographic imaging of the pancreatic duct/new possibilities using secretin stimulation. Dig Dis Sci 1987;32:1075–1081.PubMedCrossRefGoogle Scholar
  3. 3.
    Glaser J, Hogemann B, Schneider M, et al. Significance of a sonographic secretin test in the diagnosis of pancreatic diseases: results of a prospective study. Scand J Gastroenterol 1989;24:174–185.CrossRefGoogle Scholar
  4. 4.
    Lowes JR, Lees WR, Cotton PB. Pancreatic duct dilatation after secretin stimulation in patients with pancreas divisum. Pancreas 1989;4:371–374.PubMedCrossRefGoogle Scholar
  5. 5.
    Cavallini G, Rigo L, Bovo P, et al. Abnormal US response of main pancreatic duct after secretin stimulation in patients with acute pancreatitis of different etiology. J Clin Gastroenterol 1994;18:298–303.PubMedCrossRefGoogle Scholar
  6. 6.
    Matos C, Metens T, Devière J, et al. Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology 1997;203:435–441.PubMedGoogle Scholar
  7. 7.
    Manfredi R, Costamagna G, Brizi MG, et al. Severe chronic pancreatitis versus suspected pancreatic disease: dynamic MR cholangiopancreatography after secretin stimulation. Radiology 2000;214:849–855.PubMedGoogle Scholar
  8. 8.
    Manfredi R, Costamagna G, Brizi MG, et al. Pancreas divisum and santorinicele: diagnosis with dynamic MR cholangiopancreatography with secretin stimulation. Radiology 2000;217:403–408.PubMedGoogle Scholar
  9. 9.
    Matos C, Metens T, Devière J, et al. Pancreas divisum: evaluation with secretin-enhanced magentic resonance cholangiopancreatography. Gastrointest Endosc 2001;53:728–733.PubMedCrossRefGoogle Scholar
  10. 10.
    Cappeliez O, Delhaye M, Devière J, et al. Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology 2000;215:358–364.PubMedGoogle Scholar
  11. 11.
    Heverhagen JT, Muller D, Battmann A, et al. MR hydrometry to assess exocrine function of the pancreas: initial results of non invasive quantification of secretion. Radiology 2001;218:61–67.PubMedGoogle Scholar
  12. 12.
    Nanashima A, Yamagushi H, Fukuda T, et al. Evaluation of pancreatic secretion after administration of secretin: application of magnetic resonance imaging. J Gastroenterol Hepatol 2001;16:87–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Dreiling DA, Messer J. The secretin story. Am J Gastroenterol 1978;70:455–479.PubMedGoogle Scholar
  14. 14.
    Takehara Y. Fast MR imaging for evlauating the pancreaticobiliary system. Eur J Radiol 1999;29:211–232.PubMedCrossRefGoogle Scholar
  15. 15.
    Laugier R. Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis. Endoscopy 1994;26:222–227.PubMedCrossRefGoogle Scholar
  16. 16.
    Matos C, Cappeliez O, Winant C, et al. MR imaging of the pancreas: a pictorial tour. Radiographics 2002;22(1):E2.Google Scholar
  17. 17.
    Hastier P, Buckley MJ, Dumas R, et al. A study of the effect of age on pancreatic duct morphology. Gastrointest Endosc 1998;48:53–57.PubMedCrossRefGoogle Scholar
  18. 18.
    Mariani A, Curioni S, Zanello A, et al. Does aging influence the main pancreatic duct diameter measured by MR pancreatography? Digest Liver Dis 2000;32:A107.Google Scholar
  19. 19.
    Masui T, Katayama M, Kobayashi S, et al. Functional assessment of pancreatic parenchyma after secretin administration using serial T2-weighted echo-planar magnetic resonance imaging. J Magn Reson Imaging 2001;14:450–456.PubMedCrossRefGoogle Scholar
  20. 20.
    Matos C, Nicaise N, Devière J, et al. Choledochal cysts: comparison of findings at magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in eight patients. Radiology 1998;209:443–448.PubMedGoogle Scholar
  21. 21.
    Matos C, Devière J, Cremer M, et al. Acinar filling during secretin-stimulated MR pancreatography. AJR 1998;171:165–169.PubMedGoogle Scholar
  22. 22.
    Koito K, Namieno T, Ichimura T, et al. Mucin-producing pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998;208:231–237.PubMedGoogle Scholar
  23. 23.
    Lecesne R, Taourel P, Bret PM, et al. Acute pancreatitis: interobserver agreement and correlation of CT and MR cholangiopancreatography with outcome. Radiology 1999;211:727–735.PubMedGoogle Scholar
  24. 24.
    Morgan DE, Baron TH, Smith JK, et al. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 1997;203:773–778.PubMedGoogle Scholar
  25. 25.
    Neoptolemos JP, London NJ, Carr-Locke DL. Assessment of main pancreatic duct integrity by endoscopic retrograde pancreatography in patients with acute pancreatitis. Br J Surg 1993;80:94–99.PubMedCrossRefGoogle Scholar
  26. 26.
    Axon ATR, Classen M, Cotton PB, et al. Pancreatography in chronic pancreatitis: international definitions. Gut 1984;25:1107–1112.PubMedCrossRefGoogle Scholar
  27. 27.
    Ichikawa T, Sou H, Araki T, et al. Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology 2001;221:107–116.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2001

Authors and Affiliations

  • Celso Matos
    • 1
    Email author
  • Catherine Winant
    • 1
  • Myriam Delhaye
    • 1
  • Jacques Devière
    • 1
  1. 1.Department of Radiology, Division of Magnetic Resonance, Erasme HospitalFree University of BrusselsBelgium

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