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

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.