CLINICAL UTILITY OF SECRETIN MRCP FOR PANCREATIC DISEASES

Abstract

Introduction: Addition of secretin to MRCP (sMRCP) provides functional pancreatic assessment and greater detail of ductal anatomy. The clinical impact of sMRCP on the evaluation and management of various pancreatic conditions is not well-defined. Methods: Since 01/2005, 174 sMRCP studies were obtained for 5 indications: recurrent acute pancreatitis (N = 62), presumed chronic pancreatitis (36), poorly characterized abdominal pain (31), interrogation of operative anastomoses (28), and cystic lesions (17). Pre and post-secretin imaging findings were compared and impact of the functional component on clinical decision-making was analyzed. Results: Overall, use of sMRCP provided additive diagnostic value in 36% of cases. An anatomic basis for recurrent acute pancreatitis was identified based on post-secretin imaging in a quarter of cases. In chronic pancreatitis, sMRCP increased diagnostic confidence in 10 (32%) and identified 3 strictures not seen on traditional MRCP (10%). sMRCP never ruled in a pancreatic etiology in poorly characterized abdominal pain; in 10% (3/31), a normal sMRCP led to pursuit of non-pancreatic diagnoses. For interrogation of operative anastomoses, sMRCP either confirmed (43%) or negated (36%) the presence of a stricture in 79%. Anatomic detail of cystic neoplasms was clarified in 4 of 17 (24%) cases. In multivariate analysis, highest yield of sMRCP occurs in postoperative patients and those with a history of pancreatitis (p = 0.01). Conclusion: sMRCP is useful in the evaluation and management of selected pancreatic diseases, with highest yield for the postoperative setting or history of pancreatitis.