Evaluation of pancreatic exocrine function by secretin-enhanced magnetic resonance cholangiopancreatography

Aim: To assess the feasibility and usefulness of secretin-enhanced magnetic resonance cholangiopancreatography (SMRCP) for evaluation of pancreatic ex ocrine function. Methodology: S-MRCP was performed in 20 patients with mild (n = 8) or sever e (n = 12) chronic pancreatitis (according to the grade of exocrine pancrea tic insufficiency indicated by the Lundh test) and in 10 volunteers without pancreatic disease. MRCP images were evaluated before and 10 minutes after the intravenous administration of 0.5 IU/kg secretin. The changes in pancr eatic tissue T2 signal intensity and duodenal filling after the injection o f secretin were determined by means of S-MRCP. The S-MRCP findings were the n compared with those of the Lundh test. Results: The pancreatic T2 signal intensity showed a significant elevation after secretin administration in the volunteers and in the patients with mi ld or severe chronic pancreatitis. This elevation was significantly lower i n patients with mild and severe chronic pancreatitis than in the volunteers (66.85 +/- 15.77 and 24.45 +/- 5.85 vs. 200.0 +/- 45.07, respectively). Af ter administration of secretin, the diameter of the duodenum was significan tly increased in all three groups. This duodenal filling was significantly reduced in patients with mild or severe exocrine pancreatic insufficiency a s compared with the volunteers (4.12 +/- 1.33 and 1.70 +/- 0.77 vs. 15.38 /- 1.73, respectively). There was no significant difference in pancreatic T 2 signal intensity changes or in duodenal filling in patients with mild or severe exocrine pancreatic insufficiency. There were significant correlatio ns between the pancreatic T2 signal intensity changes and the duodenal fill ing and the results of the Lundh test (r = -0.616 and -0.78). Conclusion: These results demonstrate that the administration of secretin i ncreases the T2 signal intensity of the pancreatic tissue and the diameter of the duodenum to different extents in normal subjects and in patients wit h chronic pancreatitis. This suggests that S-MRCP can provide information o f value in the assessment of an exocrine pancreatic insufficiency.