1 Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, D-17475 Greifswald, Germany.
AJR Am J Roentgenol. 2014 Jan;202(1):102-8. doi: 10.2214/AJR.12.10271.
The objective of our study was to investigate secretin-stimulated MRCP in terms of the safety of secretin, improvement of duct visualization, and assessment of pancreatic exocrine function.
Eight hundred sixteen volunteers (370 women and 446 men; mean age, 49.7 ± 13.1 [SD] years) underwent 3D MRCP before and after secretin stimulation (1 U/kg of body weight) at 1.5 T. For the first 2 hours after secretin injection, subjects were evaluated for adverse reactions. Improvement of duct visualization after secretin stimulation was subjectively evaluated by two readers and was quantified by duct diameter measurements. Pancreatic exocrine function was evaluated subjectively by two readers according to the duodenal filling and was quantified using calibrated volumetric measurements of total excreted volume and pancreatic flow output.
Two subjects (0.2%) showed flushing (minor adverse reaction). Duct visualization after secretin injection was improved for reader 1 in 468 (57.4%) and for reader 2 in 478 (58.6%) subjects, was unchanged for reader 1 in 324 (39.7%) and for reader 2 in 315 (38.6%) subjects, and was worse for reader 1 in 24 (2.9%) and reader 2 in 23 (2.8%) subjects (interrater agreement, κ = 0.925). Main pancreatic duct diameters increased significantly after secretin stimulation: pancreatic head, 10.5% (mean); body, 12.5%; and tail, 7.7%. Pancreatic exocrine function evaluated according to assessment of duodenal filling was as follows: grade 0 (restricted function) in 0.7% of subjects by both readers, grade 1 (reduced function) in 4.8% of subjects by reader 1 and 4.5% of subjects by reader 2, grade 2 (low-grade reduced function) in 31.1% of subjects by reader 1 and 26.5% of subjects by reader 2, and grade 3 (physiologic function) in 63.4% of subjects by reader 1 and 68.3% of subjects by reader 2 (interrater agreement, κ = 0.838). The mean total excreted volume was 111.8 ± 49.8 (SD) mL, and the mean pancreatic flow output was 9.6 ± 4.2 mL/min.
Secretin-stimulated MRCP moderately improves main pancreatic duct visualization and allows noninvasive quantification of pancreatic exocrine function with a negligible risk of side effects.
本研究旨在探讨促胰液素刺激磁共振胰胆管成像（MRCP）的安全性、胰管显影改善情况以及胰腺外分泌功能评估。
816 名志愿者（370 名女性和 446 名男性；平均年龄，49.7±13.1[SD]岁）在 1.5T 磁共振成像仪上接受了促胰液素（1U/kg 体重）刺激前后的 3D-MRCP 检查。在注射促胰液素后 2 小时内，评估受试者的不良反应。两位阅片者对促胰液素刺激后的胰管显影改善情况进行了主观评估，并通过测量胰管直径进行量化。两位阅片者根据十二指肠充盈情况对胰腺外分泌功能进行了主观评估，并通过测量总排出量和胰液流出量的校准容积来进行量化。
2 名受试者（0.2%）出现潮红（轻微不良反应）。在 468 名受试者（57.4%）中，1 位阅片者认为胰管显影在促胰液素注射后得到改善，在 478 名受试者（58.6%）中，2 位阅片者认为胰管显影得到改善；在 324 名受试者（39.7%）中，1 位阅片者认为胰管显影无变化，在 315 名受试者（38.6%）中，2 位阅片者认为胰管显影无变化；在 24 名受试者（2.9%）中，1 位阅片者认为胰管显影变差，在 23 名受试者（2.8%）中，2 位阅片者认为胰管显影变差（组内一致性，κ=0.925）。促胰液素刺激后主胰管直径显著增加：胰头部增加 10.5%（平均值）；体部增加 12.5%；尾部增加 7.7%。根据十二指肠充盈情况评估胰腺外分泌功能如下：2 位阅片者均认为 0.7%的受试者为功能受限（0 级），4.8%的受试者（1 位阅片者）和 4.5%的受试者（2 位阅片者）为功能减退（1 级），31.1%的受试者（1 位阅片者）和 26.5%的受试者（2 位阅片者）为低级别功能减退（2 级），63.4%的受试者（1 位阅片者）和 68.3%的受试者（2 位阅片者）为生理功能（3 级）（组内一致性，κ=0.838）。总的胰液排出量为 111.8±49.8（SD）mL，胰液流出量为 9.6±4.2mL/min。
促胰液素刺激磁共振胰胆管成像可适度改善主胰管显影，并可在无明显副作用的情况下对胰腺外分泌功能进行非侵入性定量评估。
