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Original research article


Role of secretin-enhanced magnetic resonance cholangiopancreatography in the evaluation of patients following pancreatojejunostomy.

Munazza AnisKoenraad Mortele
Departments of Radiology, Medical University of South Carolina, Charleston, SC, USA, Beth Israel Deaconess Medical Center, Boston, MA, USA
Date of Submission: 16-Dec-2012, Date of Acceptance: 23-Dec-2012, Date of Web Publication: 28-Feb-2013.
Corresponding Author:
Corresponding Author

Munazza Anis

Department of Radiology, Medical University of South Carolina, 1479, Long Grove Drive, Apt 103, Mount Pleasant, SC 29464, USA.
E-mail: anis@musc.edu

Corresponding Author:
Corresponding Author

Munazza Anis

Department of Radiology, Medical University of South Carolina, 1479, Long Grove Drive, Apt 103, Mount Pleasant, SC 29464, USA.
E-mail: anis@musc.edu

DOI: 10.4103/2156-7514.107909 Facebook Twitter Google Linkedin

ABSTRACT



Objective: This study was conducted to assess the role of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in the evaluation of patients following pancreatico-jejunal anatomosis.
Materials and Methods: S-MRCP studies (n = 83) performed at Brigham and Women’s Hospital between 1/2005 and 7/2005 were retrospectively reviewed. Among these, there were 13 patients (10 females, 3 males; mean age = 45 years, range = 18-74 years) who were evaluated with S-MRCP following pancreatojejunal anatomosis. Single-shot fast spin-echo T2-weighted thick slab dynamic MRCP images obtained before and every minute (for 10 min) after IV injection of secretin (2 mcg/kg body weight of SecreFloTM IV over 1 min) were reviewed retrospectively and independently by 3 readers. Image analysis included measurement of the main pancreatic duct (MPD) diameter and subjective assessment of the grade of visualization of the MPD remnant. The amount of jejunal fluid and visualization of the pancreatico-jejunal anatomosis pre-and post-secretin were also documented. Direct correlation with endoscopic retrograde cholangiopancreatography (ERCP) finding was available in six of the 13 cases.
Results: The MPD diameter and MPD remnant visualization improved post-secretin for 1/3 readers. The number of pancreatico-jejunal anastomoses and the amount of jejunal fillings pre-and post-secretin was seen to improve significantly for 1 of the 3 readers. For Reader 1, the mean MPD diameter in the body of the pancreas, on the pre-and post-secretin image, was 3.2 ± 1.3 mm and 3.8 ± 1.9 mm, respectively. There was no statistical difference in the values pre- and post-secretin in the MPD diameter(P = 0.07), MPD visualization (P = 0.16) and the number of pancreatico-jejunal anastomoses seen (P = 0.125 5/13 pre- and 9/13 post-secretin). Statistical significance was seen in the amount of jejunal filling (P = 0.01) after secretin. For Reader 2, the MPD diameter pre-and post-secretin was 4 ± 2 and 3.9 ± 2.1 mm, respectively (P = 0.89). The MPD visualization (P = 0.19) and degree of jejunal filling (P = 0.7) did not improve significantly. There were 3/13 pancreatico-jejunostomy anastomoses seen pre- and 8/13 seen post-secretin (P = 0.06). The values for Reader 3 reached a statistical significance for the measurement of MPD (P = 0.032). In addition, MPD visualization (P = 0.038), the number of anastomoses seen (P = 0.016) and jejunal filling (P = 0.006) were also significantly improved.
Conclusion: The addition of intravenous secretin to an MRCP study in the evaluation of patients following pancreatojejunal anastomosis does not significantly impact the visualization of the pancreatic duct. However, secretin may improve the assessment of the pancreatico-jejunal anastomosis.
Keywords: Magnetic Resonance Cholangiopancreatography, Partial Pancreatectomy, Secretin

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  1. S.G. De La Fuente and T.N. Pappas (2017) Reference Module in Neuroscience and Biobehavioral Psychology. . doi: 10.1016/B978-0-12-809324-5.03309-5
  2. Nima Hafezi-Nejad, Vikesh K. Singh, Mahya Faghih, Ihab R. Kamel and Atif Zaheer (2019) Jejunal response to secretin is independent of the pancreatic response in secretin-enhanced magnetic resonance cholangiopancreatography. European Journal of Radiology 112:7. doi: 10.1016/j.ejrad.2018.12.024
  3. L. Grenacher and M. Juchems (2017) Resektabilitätskriterien beim Pankreaskarzinom und postoperative Bildgebung. Radiologe 57(12):1075. doi: 10.1007/s00117-017-0326-8
  4. Akihiko Kida, Yukihiro Shirota, Yuji Houdo and Tokio Wakabayashi (2016) Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature. Therap Adv Gastroenterol 9(6):913. doi: 10.1177/1756283X16663877
  5. Bella Chamokova, Nina Bastati, Sarah Poetter-Lang, Yesim Bican, Jacqueline C Hodge, Martin Schindl, Celso Matos and Ahmed Ba-Ssalamah (2018) The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases. BJR :20170677. doi: 10.1259/bjr.20170677
  6. Adnan Madzak, Søren Schou Olesen, Gaute Kjellevold Wathle, Ingfrid Salvesen Haldorsen, Asbjørn Mohr Drewes and Jens Brøndum Frøkjær (2016) Secretin-Stimulated Magnetic Resonance Imaging Assessment of the Benign Pancreatic Disorders. Pancreas 45(8):1092. doi: 10.1097/MPA.0000000000000606
  7. Olga R. Brook, Sami Abedin and Koenraad J. Mortele (2013) Magnetic Resonance Imaging of the Postoperative Pancreas. Seminars in Ultrasound, CT and MRI 34(4):325. doi: 10.1053/j.sult.2013.04.001

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