Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis

Adnan Madzak; Søren Schou Olesen; Ingfrid Salvesen Haldorsen; Asbjørn Mohr Drewes; Jens Brøndum Frøkjær

doi:10.1016/j.pan.2017.01.009

Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis

Pancreatology. 2017 Mar-Apr;17(2):228-236. doi: 10.1016/j.pan.2017.01.009. Epub 2017 Jan 27.

Authors

Adnan Madzak¹, Søren Schou Olesen², Ingfrid Salvesen Haldorsen³, Asbjørn Mohr Drewes², Jens Brøndum Frøkjær⁴

Affiliations

¹ Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.
² Centre for Pancreatic Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
³ Department of Radiology, Haukeland University Hospital, Bergen, Norway; Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁴ Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address: jebf@rn.dk.

PMID: 28162928
DOI: 10.1016/j.pan.2017.01.009

Abstract

Background/objectives: Chronic pancreatitis (CP) is characterized by abnormal pancreatic morphology and impaired endocrine and exocrine function. However, little is known about the relationship between pancreatic morphology and function, and also the association with the etiology and clinical manifestations of CP. The aim was to explore pancreatic morphology and function with advanced MRI in patients with CP and healthy controls (HC) METHODS: Eighty-two patients with CP and 22 HC were enrolled in the study. Morphological imaging parameters included pancreatic main duct diameter, gland volume, fat signal fraction and apparent diffusion coefficient (ADC) values. Functional secretin-stimulated MRI (s-MRI) parameters included pancreatic secretion (bowel fluid volume) and changes in pancreatic ADC value before and after secretin stimulation. Patients were classified according to the modified Cambridge and M-ANNHEIM classification system and fecal elastase was collected.

Results: All imaging parameters differentiated CP patients from HC; however, correlations between morphological and functional parameters in CP were weak. Patients with alcoholic and non-alcoholic etiology had comparable s-MRI findings. Fecal elastase was positively correlated to pancreatic gland volume (r = 0.68, P = 0.0016) and negatively correlated to Cambridge classification (r = -0.35, P < 0.001). Additionally, gland volume was negatively correlated to the duration of CP (r = -0.39, P < 0.001) and baseline ADC (r = -0.35, P = 0.027). When stratified by clinical stage (M-ANNHEIM), the pancreatic gland volume was significantly decreased in the severe stages of CP (P = 0.001).

Conclusions: S-MRI provides detailed information about pancreatic morphology and function and represents a promising non-invasive imaging method to characterize pancreatic pathophysiology and may enable monitoring of disease progression in patients with CP.

Keywords: Chronic pancreatitis; DWI; M-ANNHEIM clinical staging; Pancreatic gland volume; s-MRI.

MeSH terms

Aged
Feces / chemistry
Female
Humans
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Pancreas / pathology*
Pancreatic Elastase / analysis
Pancreatic Elastase / chemistry
Pancreatic Elastase / metabolism
Pancreatitis, Chronic / diagnostic imaging*
Pancreatitis, Chronic / pathology*
Secretin / pharmacology*

Substances

Secretin
Pancreatic Elastase