Chronic pancreatitis: Evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation

PURPOSE: To compare duodenal filling seen at magnetic resonance (MR) pancre atography after secretin stimulation and biochemical parameters determined with the intraductal secretin test (IDST) for evaluation of pancreatic exoc rine function. MATERIALS AND METHODS: MR pancreatography after secretin stimulation and ID ST were performed in 41 patients with chronic pancreatitis (group 1) and ei ght patients with other pancreatic disease (group 2). A control group (grou p 3, n = 28) underwent MR pancreatography after secretin stimulation only. MR pancreatograms were acquired before and every 30 seconds for 10 minutes after secretin injection. Duodenal filling was graded from least amount of filling (grade 1) to normal filling (grade 3) on the last MR pancreatogram. Pancreatic exocrine function was determined at IDST, Main pancreatic ducta l diameter was compared between groups 1 and 3. RESULTS: All ductal diameters were significantly larger in group 1 (P < .00 1). The maximal diameter variation after secretin stimulation was significa ntly higher in the control group (P = .001). pancreatic exocrine function p arameters determined at IDST were significantly lower in patients with grad e 1 duodenal filling than in those with grade 2 or 3 (P < .05). Maximal bic arbonate concentration alone was independently associated with all grades o f duodenal filling (P = .007). The sensitivity and specificity of reduced d uodenal filling for assessment of reduced pancreatic exocrine function were 72% and 87%, respectively. CONCLUSION: Duodenal filling grade determined at MR pancreatography after s ecretin stimulation allows specific estimation of pancreatic exocrine funct ion.