Severe chronic pancreatitis versus suspected pancreatic disease: Dynamic MR cholangiopancreatography after secretin stimulation

PURPOSE: To assess whether secretin stimulation improves visualization of t he pancreatic ducts at magnetic resonance (MR) cholangiopancreatography (MR CP) in patients with severe chronic pancreatitis or suspected pancreatic di sease. MATERIALS AND METHODS: Thirty-one patients (group 1)with chronic pancreatit is and 84 patients (group 2) with clinical and/or laboratory findings sugge stive of pancreatic disease who did not have ductal alterations at ultrason ography (US) and/or computed tomography (CT) underwent MRCP before and up t o 10 minutes after secretin stimulation. Size of the main pancreatic duct ( head, body, tail) and duodenal filling before and after secretin stimulatio n were measured quantitatively. Image quality, number of main pancreatic du ctal segments visualized, visualization of side branches, ductal narrowing, endoluminal filling defects, and presence of pancreas divisum were analyze d qualitatively. RESULTS: In both groups, the size of the main pancreatic duct increased sig nificantly 3 minutes after secretin stimulation. Reduced duodenal filling w as detected in patients with severe chronic pancreatitis (P < .001). The nu mber of segments of the main pancreatic duct visualized improved from 85 (9 1%) to 93 (100%) of 93 in group 1 and from 164 (65%) to 245 (97%) of 252 (P < .001) in group 2. Visualization of side branches improved from 22 (71%) to 31 (100%) of 31 in group 1 and from three (4%) to 53 (63%) of 84 (P < .0 01) in group 2. Pancreas divisum was visualized in one additional patient i n group 1 and in six additional patients in group 2. CONCLUSION: The administration of secretin improves visualization of the pa ncreatic ducts and helps in the evaluation of exocrine reserve.