ROUTINE, CLINICAL (MRCP) REPORTING CORRELATES WITH ABNORMAL PANCREAS FUNCTION BUT FAILS TO QUANTIFY SECRETORY DYNAMICS

Abstract

Background: Studies suggests that MRCP can assess pancreatic secretory reserve/function. Composite interpretation methods and quantitative dynamics reported are not routinely measured in clinical practice. The diagnostic accuracy of MRCP in routine clinical setting is unknown. Study Design: Cross-sectional study of pts with CP and suspected CP who underwent MRCP and pancreatic function testing (ePFT). Aims: To determine the referent values of routine MRI findings when compared to pancreatic function test. Methods: An IRB approved study (CCF08-259). Source population: Pancreas Clinic at tertiary referral center (CCF). MRCP and sMRCP reports were reviewed (PZ, DLC) to record pancreas duct (dilation, side branch changes), parenchyma enhancement (T1, T2 signal) and physiologic response (duodenal filling, pancreas duct response) to secretin. ePFT categorized based on cutpoint 80 meq/L. Referent values were calculated for MRCP compared with the secretin ePFT (P < 0.05). Results: Of the 69 patients, 28 (40.6%) had abnormal ePFT. Overall diagnostic accuracy, sensitivity and specificity were 70, 85 and 46% respectively. There was fair agreement of MRCP and ePFT (kappa 0.335, [0.113, 0.557]). Peak bicarbonate decreased as degree of severity increased (P = 0.0016). The PRE_STIMULATION pancreas duct changes was found to predict abnormal pancreas function (P = 0.002). The POST-STIMULATION findings (duodenal filling, T2 enhancement or change in pancreas duct) did not enhance agreement. Conclusions: Pancreas ductal features correlate with abnormal pancreas function. Current MRCP studies, report other subjective findings that are poor predictors of exocrine function.