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Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population

  • Hepatobiliary-Pancreas
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Abstract

Objectives

To investigate the frequency of pancreatic duct (PD) variants and their effect on pancreatic exocrine function in a population-based study using non-invasive secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP).

Methods

Nine hundred and ninety-five volunteers, 457 women and 538 men, aged 51.9 ± 13.4 years, underwent navigator-triggered, T2-weighted, 3D turbo spin echo MRCP on a 1.5 T system after 1 unit/kg secretin administration. Two readers evaluated images for PD variants. Pancreatic exocrine function and morphological signs of chronic pancreatitis such as abnormalities of the main PD, side branch dilatation, and pancreatic cysts were evaluated and related to PD variants using a Kruskal-Wallis test and post hoc analysis.

Results

Of all sMRCP, 93.2 % were of diagnostic quality. Interobserver reliability for detection of PD variants was found to be kappa 0.752 (95 %CI, 0.733 – 0.771). Normal PD variants were observed in 90.4 % (n = 838/927). Variants of pancreas divisum was identified in 9.6 % (n = 89/927). Abnormalities of the main PD, side branch dilatation, and pancreatic cysts were observed in 2.4 %, 16.6 %, and 27.7 %, respectively, and were not significantly different between pancreas divisum and non-divisum group (P = 0.122; P = 0.152; P = 0.741). There was no association between PD variants and pancreatic exocrine function (P = 0.367).

Conclusion

PD variants including pancreas divisum are not associated with morphological signs of chronic pancreatitis or restriction of pancreatic exocrine function.

Key Points

• MRCP allows the evaluation of pancreatic duct variants and morphological change.

• Pancreatic duct variants are not associated with morphological signs of chronic pancreatitis.

• Pancreas divisum is not accompanied by restriction of pancreatic exocrine function.

• Pancreatic duct variants including pancreas divisum are limited in their clinical relevance.

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Abbreviations

PD:

Pancreatic duct

sMRCP:

Secretin-stimulated magnetic resonance cholangiopancreatography

CP:

Chronic pancreatitis

MRCP:

Magnetic resonance cholangiopancreatography

ERCP:

Endoscopic retrograde cholangiopancreatography

MRI:

Magnetic resonance imaging

TSE:

Turbo spin echo

MIP:

Maximum-intensity projection

APD:

Accessory pancreatic duct

MPD:

Main pancreatic duct

CBD:

Common bile duct

TEV:

Total excreted volume

PFO:

Pancreatic flow output

BMI:

Body mass index

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Acknowledgements

The scientific guarantor of this publication is: Jens-Peter Kühn, MD, PhD; Department of Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald Ferdinand-Sauerbruch-Straße 1 Greifswald 17475, Germany. kuehn@uni-greifswald.de. The authors of this manuscript declare relationships with the following companies: the Eva Luise and Horst Köhler Foundation, by the Deutsche Krebshilfe/Dr.Mildred-Scheel-Stiftung (109102), the Deutsche Forschungsgemeinschaft (DFG GRK840-D2/E3/E4, MA 4115/1-2/3, EV 168/2-1), the Federal Ministry of Education and Research (BMBF GANI-MED 03IS2061A and BMBF 0314107, 01ZZ9603, 01ZZ0103, 01ZZ0403, 03ZIK012), and the European Union (EU-FP-7: EPC-TM and EU-FP7-REGPOT-2010-1). This study has received funding by: the Community Medicine Research net (CMR) of the University of Greifswald, Germany. The CMR encompasses several research projects that share data from the population-based SHIP project (http://ship.community-medicine.de).

SHIP is funded by following institutions: Federal Ministry of Education and Research (grants 01ZZ9603, 01ZZ0103, 01ZZ0403, 01ZZ0701, 03ZIK012), Ministry of Cultural Affairs as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania, Federal Ministry of Nutrition, Agriculture and Consumer’s Safety (07HS003), German Research Foundation (projects Gr 1912/5-1, Ko 799/5-1, Vo 955/5-1, Vo 955/6-1, Vo 955/10-1), Competence Network Heart Failure (01GI0205), Competence Network Diabetes (01GI0855), German Asthma and COPD Network (COSYCONET; BMBF 01GI0883), Genopathomik (BMBF FZK 03138010), Alfried Krupp von Bohlen und Halbach Foundation, Alexander v. Humboldt Foundation, Leibniz Society, Siemens AG, Health Care Sector (Erlangen, Germany), Pfizer Pharma GmbH (SBU Endocrinology and Ophthalmology; Berlin Germany), Novo Nordisk (Mainz, Germany), Data Input GmbH (Darmstadt, Germany), GABA International AG (Therwil, Switzerland), Imedos Systems (Jena, Germany), and Heinen and Löwenstein (Bad Ems, Germany). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. The local ethics committee approved the study, and written informed consent was obtained from all participating volunteers before secretin-stimulated MRCP.

Approval from the institutional animal care committee was not required because animals were not part of the study. Some study subjects or cohorts have been previously reported in: the population-based Study of Health in Pomerania (SHIP), which is a project conducted in Northeast Germany. The objectives of this interdisciplinary study are to estimate the occurrence of diseases findings and further associations.

The method for calculation of pancreatic flow output was previously published in Mensel et al. 2014. (Mensel B, Messner P, Mayerle J, et al. (2014) Secretin-Stimulated MRCP in Volunteers: Assessment of Safety, Duct Visualization, and Pancreatic Exocrine Function. AJR Am J Roentgenol 202: 102-108. Doi: 10.2214/AJR.12.10271

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Authors and Affiliations

  1. Department of Radiology and Neuroradiology, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, Greifswald, 17475, Germany

    Robin Bülow, Robert Thiel, Patrick Thamm, Philip Messner, Norbert Hosten & Jens-Peter Kühn

  2. Division of Gastroenterology and Department of Medicine A, University Medicine, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Straße 1, Greifswald, 17475, Germany

    Peter Simon, Markus M. Lerch & Julia Mayerle

  3. Institute for Community Medicine, University Medicine, Ernst Moritz Arndt University Greifswald, Walther Rathenau Straße 48, Greifswald, 17475, Germany

    Henry Völzke

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  1. Robin Bülow
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Correspondence to Robin Bülow.

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Bülow, R., Simon, P., Thiel, R. et al. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. Eur Radiol 24, 3142–3149 (2014). https://doi.org/10.1007/s00330-014-3359-7

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  • DOI: https://doi.org/10.1007/s00330-014-3359-7

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