Does Secretin-stimulated MRCP Predict Exocrine Pancreatic Insufficiency? A Comparison With Noninvasive Exocrine Pancreatic Function Tests

Background: Data on magnetic resonance cholangiopancreato-graphy with secretin stimulation (S-MRCP) for the assessment of exocrine pancreatic insufficiency (EPI) are limited. We com-pared pancreatic function tests with the findings of S-MRCP in patients with chronic pancreatitis (CP) and disease controls. Methods: S-MRCP was performed in 23 patients (18 CP, 5 disease controls). MRCP images were analyzed for secretin-induced duodenal liquid filling (0=no filling; 1=duodenal bulb; 2=up to lower flexure; 3=beyond lower flexure). EPI was evaluated by fecal elastase, fecal fat concentration, and a 13C mixed chain triglyceride breath test. Clinically relevant EPI was stated if 2 of 3 tests were pathologic. Results: EPI was diagnosed in 10 of 18 patients with CP. Patients without EPI showed either grade 2 (n=4) or grade 3 (n=9) duodenal filling, whereas only 1/10 patients with EPI showed grade 3 duodenal filling. Sensitivity and specificity of S-MRCP for the diagnosis of EPI were 69 % and 90%, respectively. Conclusions: Assessment of duodenal filling should be per-formed in patients who undergo S-MRCP for the evaluation of pancreatic morphology. However, minor degrees of duodenal filling are equivocal and require further diagnostic evaluation. Key Words: chronic pancreatitis, exocrine pancreatic insuffi-ciency, MRCP, secreti