Secretin-stimulated MR cholangio-pancreatography in the evaluation of asymptomatic patients with non-specific pancreatic hyperenzymemia

Abstract

Purpose To assess the diagnostic value of secretin-stimulated MRCP (SS-MRCP) compared with conventional MRCP in asymptomatic patients with mild elevations of pancreatic enzymes. Materials and methods Eighty asymptomatic patients with pancreatic hyperenzymemia underwent MR imaging at 1.5 T-device (Signa EXCITE, GE Healthcare). After the acquisition of axial T1w,T2w sequences, and conventional MRCP, SS-MRCP was performed using a single-slice coronal breath-hold, thick-slab, SSFSE T2w sequence, repeated every 30 s up to 15 min following intravenous injection of secretin (Secrelux ®, Sanochemia). Results On the basis of the standards of reference, our final diagnoses were: negative findings ( n = 23), pancreas divisum ( n = 22), mild chronic pancreatitis ( n = 14), inflammatory ampullary stenosis ( n = 3), juxtapapillary duodenal diverticulum ( n = 1), small cystic lesions (<1 cm) ( n = 22; 5/22 cases associated with pancreas divisum). The image quality of SS-MRCP was significantly higher than that of conventional MRCP ( p < 0.0001). Standards of reference did not differ significantly from of SS-MRCP findings ( p = 0.5), while was statistically different from those of conventional MRCP ( p < 0.0001). A significant difference was found between conventional MRCP and SS-MRCP findings ( p < 0.0001). Conclusion In asymptomatic patients with non-specific pancreatic hyperenzymemia SS-MRCP may represent the best non-invasive diagnostic technique, since it gives morphological and functional information.