Abstract
ObjectivesSecretin-stimulated magnetic resonance imaging (s-MRI) is the best validated radiological modality assessing pancreatic secretion. The purpose of this study was to compare volume output measures from secretin-stimulated transabdominal ultrasonography (s-US) to s-MRI for the diagnosis of exocrine pancreatic failure in cystic fibrosis (CF).MethodsWe performed transabdominal ultrasonography and MRI before and at timed intervals during 15 minutes after secretin stimulation in 21 CF patients and 13 healthy controls. To clearly identify the subjects with reduced exocrine pancreatic function, we classified CF patients as pancreas-sufficient or -insufficient by secretin-stimulated endoscopic short test and faecal elastase.ResultsPancreas-insufficient CF patients had reduced pancreatic secretions compared to pancreas-sufficient subjects based on both imaging modalities (p < 0.001). Volume output estimates assessed by s-US correlated to that of s-MRI (r = 0.56–0.62; p < 0.001). Both s-US (AUC: 0.88) and s-MRI (AUC: 0.99) demonstrated good diagnostic accuracy for exocrine pancreatic failure.ConclusionsPancreatic volume-output estimated by s-US corresponds well to exocrine pancreatic function in CF patients and yields comparable results to that of s-MRI. s-US provides a simple and feasible tool in the assessment of pancreatic secretion.Key points• Cystic fibrosis patients with affected pancreas have reduced pancreatic secretions.• Secretin-stimulated sonography is a simple and feasible method to assess pancreatic output.• Secretin-simulated MRI is a more precise method to assess pancreatic secretions.• The sonographic and MRI methods yielded comparable pancreatic secretory output estimates.
Highlights
MethodsCystic fibrosis (CF) is caused by a range of different mutations of the cystic fibrosis (CF) transmembrane receptor CFTR gene [1]
Pancreatic volume-output estimated by secretinstimulated transabdominal ultrasonography (s-US) corresponds well to exocrine pancreatic function in CF patients and yields comparable results to that of stimulated magnetic resonance imaging (s-MRI). s-US provides a simple and feasible tool in the assessment of pancreatic secretion
We have recently demonstrated that secretin-stimulated transabdominal ultrasonography (s-US) can detect reduced pancreatic secretion in various pancreatic diseases, and best accuracy for exocrine pancreatic failure was achieved for the method in CF patients [17]
Summary
MethodsCystic fibrosis (CF) is caused by a range of different mutations of the CF transmembrane receptor CFTR gene [1]. The mechanism of pancreatic failure in CF is related to lack of or impaired function of the CFTR protein located in the cell membrane of the pancreatic ductal epithelium [2, 3]. Indicators of pancreatic CFTR function are pancreatic output-volume and pancreatic juice contents of chloride and bicarbonate [3]. This has been utilised in tube-based tests diagnosing pancreas exocrine insufficiency in CF patients [8], and recently by our group, measuring bicarbonate concentration in duodenal juice from a secretin-stimulated endoscopic short test with excellent diagnostic accuracy [9]
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