MRI Assessment and Functional Evaluation of Chronic Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yuanyuan , HUANG Zixing ,  SONG Bin

Department of Radiology， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

Chronic pancreatitis; Magnetic resonance imaging; MR cholangiopancreatography; Diffusion weighted imaging; Secretin

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Objective 　To investigate the magnetic resonance imaging （MRI） assessment and functional evaluation of chronic pancreatitis （CP）.
Methods 　Literatures about MRI assessment of CP （especially the evaluation of pancreatic exocrine function with MRI） were reviewed.
Results 　Some early parenchymal changes （pancreatic size，signal intensity of pancreas， and enhancement pattern） in the CP could be visualized by MRI；ductal changes could be visualized by MR cholangiopancreatography （MRCP）；and secretin-stimulated MRCP （combination of both morphologic and functional evaluation） not only improved the visualization of pancreatic duct and side branches，but also allowed evaluation of the pancreatic exocrine function noninvasively. Secretin-stimulated diffusion weighted imaging also could be used as a noninvasive method to assess pancreatic exocrine function.
Conclusions 　Conventional MRI and （or） secretin-stimulated MRI can become valuable means in CP （especially early-stage CP）， with furnishing morphologic and functional information simultaneously. However，further research is needed to verify the diagnostic accuracy of these modalities.

Citation： LIU Yuanyuan,HUANG Zixing,SONG Bin,.. MRI Assessment and Functional Evaluation of Chronic Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(2): 216-220. doi: Copy

1.	Forsmark CE. The early diagnosis of chronic pancreatitis[J]. Clin Gastroenterol Hepatol， 2008， 6(12)：1291-1293.
2.	Czakó L. Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography[J]. J Gastroenterol， 2007， 42 Suppl 17：113-117.
3.	Stevens T， Conwell DL， Zuccaro G. Pathogenesis of chronic pancreatitis：an evidence-based review of past theories and recent developments[J]. Am J Gastroenterol， 2004， 99(11)：2256-2270.
4.	Etemad B， Whitcomb DC. Chronic pancreatitis：diagnosis， classification， and new genetic developments[J]. Gastroenterology， 2001， 120(3)：682-707.
5.	Steer ML， Waxman I， Freedman S. Chronic pancreatitis[J]. N Engl J Med， 1995， 332(22)：1482-1490.
6.	Tamura R， Ishibashi T， Takahashi S. Chronic pancreatitis：MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation[J]. Radiology， 2006， 238(3)：920-928.
7.	Coakley FV， Schwartz LH. Magnetic resonance cholangiopancreatography[J]. J Magn Reson Imaging， 1999， 9(2)：157–162.
8.	Takehara Y. Can MRCP replace ERCP?[J]. J Magn Reson Imaging， 1998， 8(3)：517-534.
9.	Matos C， Metens T， Devière J， et al. Pancreatic duct：morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation[J]. Radiology， 1997， 203(2)：435-441.
10.	Cappeliez O， Delhaye M， Devière J， et al. Chronic pancreatitis：evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation[J]. Radiology， 2000， 215(2)：358-364.
11.	Balci NC， Smith A， Momtahen AJ， et al. MRI and S-MRCP findings in patients with suspected chronic pancreatitis：correlation with endoscopic pancreatic function testing (ePFT)[J]. J Magn Reson Imaging， 2010， 31(3)：601-606.
12.	Schneider AR， Hammerstingl R， Heller M， et al. Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency? A comparison with noninvasive exocrine pancreatic function tests[J]. J Clin Gastroenterol， 2006， 40(9)：851-855.
13.	Manfredi R， Costamagna G， Brizi MG， et al. Severe chronic pancreatitis versus suspected pancreatic disease：dynamic MR cholangiopancreatography after secretin stimulation[J]. Radiology， 2000， 214(3)：849-855.
14.	Sanyal R， Stevens T， Novak E， et al. Secretin-enhanced MRCP：review of technique and application with proposal for quantification of exocrine function[J]. AJR Am J Roentgenol， 2012， 198(1)：124-132.
15.	Manfredi R， Perandini S， Mantovani W， et al. Quantitative MRCP assessment of pancreatic exocrine reserve and its correlationwith faecal elastase-1 in patients with chronic pancreatitis[J]. Radiol Med， 2012， 117(2)：282-292.
16.	Schlaudraff E， Wagner HJ， Klose KJ， et al. Prospective evaluation of the diagnostic accuracy of secretin-enhanced magnetic resonance cholangiopancreaticography in suspected chronic pancreatitis[J]. Magn Reson Imaging， 2008， 26(10)：1367-1373.
17.	Sai JK， Suyama M， Kubokawa Y， et al. Diagnosis of mild chronic pancreatitis (Cambridge classification)：comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography[J]. World J Gastroenterol， 2008， 14(8)：1218-1221.
18.	Chopra A， Alkaade S， Balci NC， et al. The effect of prior sphincterotomy on the secretin-stimulated magnetic resonance cholangiopancreatography (s-MRCP)[J]. Acad Radiol， 2009， 16(11)：1381-1385.
19.	Erturk SM， Ichikawa T， Motosugi U， et al. Diffusion-weighted MR imaging in the evaluation of pancreatic exocrine function before and after secretin stimulation[J]. Am J Gastroenterol， 2006， 101(1)：133-136.
20.	Balcı C. MRI assessment of chronic pancreatitis[J]. DiagnInterv Radiol， 2011， 17(3)：249-254.
21.	Akisik MF， Aisen AM， Sandrasegaran K， et al. Assessment of chronic pancreatitis：utility of diffusion-weighted MR imaging with secretin enhancement[J]. Radiology， 2009， 250(1)：103-109.
22.	Akisik MF， Sandrasegaran K， Jennings SG， et al. Diagnosis of chronic pancreatitis by using apparent diffusion coefficient measurements at 3.0-T MR following secretin stimulation[J]. Radiology， 2009， 252(2)：418-425.
23.	Balci NC， Momtahen AJ， Akduman EI， et al. Diffusion-weightedMRI of the pancreas：correlation with secretin endoscopic pancreatic function test (ePFT)[J]. Acad Radiol， 2008， 15(10)：1264-1268.
24.	Balci NC， Alkaade S， Magas L， et al. Suspected chronic pancre-atitis with normal MRCP：findings on MRI in correlation withsecretin MRCP[J]. J Magn Reson Imaging， 2008， 27(1)：125-131.
25.	Alkaade S， Cem Balci N， Momtahen AJ， et al. Normal pancreatic exocrine function does not exclude MRI/MRCP chronic pancreatitis findings[J]. J Clin Gastroenterol， 2008， 42(8)：950-955.
26.	Balci NC， Bieneman BK， Bilgin M， et al. Magnetic resonance imaging in pancreatitis[J]. Top Magn Reson Imaging， 2009， 20(1)：25-30.
27.	Bilgin M， Bilgin S， Balci NC， et al. Magnetic resonance imagingand magnetic resonance cholangiopancreatography findings compared with fecal elastase 1 measurement for the diagnosis of chronic pancreatitis[J]. Pancreas， 2008， 36(1)：e33-e39.
28.	Sugiyama M， Haradome H， Atomi Y. Magnetic resonanceimaging for diagnosing chronic pancreatitis[J]. J Gastroenterol， 2007， 42 Suppl 17：108-112.
29.	Zuccaro P， Stevens T， Repas K， et al. Magnetic resonance cholangiopancreatography reports in the evaluation of chronic pancreatitis：a need for quality improvement[J]. Pancreatology， 2009， 9(6)：764-769.
30.	Sainani NI， Conwell DL. Secretin-enhanced MRCP：proceed with cautious optimism[J]. Am J Gastroenterol， 2009， 104(7)：1787-1789.

1. Forsmark CE. The early diagnosis of chronic pancreatitis[J]. Clin Gastroenterol Hepatol， 2008， 6(12)：1291-1293.
2. Czakó L. Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography[J]. J Gastroenterol， 2007， 42 Suppl 17：113-117.
3. Stevens T， Conwell DL， Zuccaro G. Pathogenesis of chronic pancreatitis：an evidence-based review of past theories and recent developments[J]. Am J Gastroenterol， 2004， 99(11)：2256-2270.
4. Etemad B， Whitcomb DC. Chronic pancreatitis：diagnosis， classification， and new genetic developments[J]. Gastroenterology， 2001， 120(3)：682-707.
5. Steer ML， Waxman I， Freedman S. Chronic pancreatitis[J]. N Engl J Med， 1995， 332(22)：1482-1490.
6. Tamura R， Ishibashi T， Takahashi S. Chronic pancreatitis：MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation[J]. Radiology， 2006， 238(3)：920-928.
7. Coakley FV， Schwartz LH. Magnetic resonance cholangiopancreatography[J]. J Magn Reson Imaging， 1999， 9(2)：157–162.
8. Takehara Y. Can MRCP replace ERCP?[J]. J Magn Reson Imaging， 1998， 8(3)：517-534.
9. Matos C， Metens T， Devière J， et al. Pancreatic duct：morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation[J]. Radiology， 1997， 203(2)：435-441.
10. Cappeliez O， Delhaye M， Devière J， et al. Chronic pancreatitis：evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation[J]. Radiology， 2000， 215(2)：358-364.
11. Balci NC， Smith A， Momtahen AJ， et al. MRI and S-MRCP findings in patients with suspected chronic pancreatitis：correlation with endoscopic pancreatic function testing (ePFT)[J]. J Magn Reson Imaging， 2010， 31(3)：601-606.
12. Schneider AR， Hammerstingl R， Heller M， et al. Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency? A comparison with noninvasive exocrine pancreatic function tests[J]. J Clin Gastroenterol， 2006， 40(9)：851-855.
13. Manfredi R， Costamagna G， Brizi MG， et al. Severe chronic pancreatitis versus suspected pancreatic disease：dynamic MR cholangiopancreatography after secretin stimulation[J]. Radiology， 2000， 214(3)：849-855.
14. Sanyal R， Stevens T， Novak E， et al. Secretin-enhanced MRCP：review of technique and application with proposal for quantification of exocrine function[J]. AJR Am J Roentgenol， 2012， 198(1)：124-132.
15. Manfredi R， Perandini S， Mantovani W， et al. Quantitative MRCP assessment of pancreatic exocrine reserve and its correlationwith faecal elastase-1 in patients with chronic pancreatitis[J]. Radiol Med， 2012， 117(2)：282-292.
16. Schlaudraff E， Wagner HJ， Klose KJ， et al. Prospective evaluation of the diagnostic accuracy of secretin-enhanced magnetic resonance cholangiopancreaticography in suspected chronic pancreatitis[J]. Magn Reson Imaging， 2008， 26(10)：1367-1373.
17. Sai JK， Suyama M， Kubokawa Y， et al. Diagnosis of mild chronic pancreatitis (Cambridge classification)：comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography[J]. World J Gastroenterol， 2008， 14(8)：1218-1221.
18. Chopra A， Alkaade S， Balci NC， et al. The effect of prior sphincterotomy on the secretin-stimulated magnetic resonance cholangiopancreatography (s-MRCP)[J]. Acad Radiol， 2009， 16(11)：1381-1385.
19. Erturk SM， Ichikawa T， Motosugi U， et al. Diffusion-weighted MR imaging in the evaluation of pancreatic exocrine function before and after secretin stimulation[J]. Am J Gastroenterol， 2006， 101(1)：133-136.
20. Balcı C. MRI assessment of chronic pancreatitis[J]. DiagnInterv Radiol， 2011， 17(3)：249-254.
21. Akisik MF， Aisen AM， Sandrasegaran K， et al. Assessment of chronic pancreatitis：utility of diffusion-weighted MR imaging with secretin enhancement[J]. Radiology， 2009， 250(1)：103-109.
22. Akisik MF， Sandrasegaran K， Jennings SG， et al. Diagnosis of chronic pancreatitis by using apparent diffusion coefficient measurements at 3.0-T MR following secretin stimulation[J]. Radiology， 2009， 252(2)：418-425.
23. Balci NC， Momtahen AJ， Akduman EI， et al. Diffusion-weightedMRI of the pancreas：correlation with secretin endoscopic pancreatic function test (ePFT)[J]. Acad Radiol， 2008， 15(10)：1264-1268.
24. Balci NC， Alkaade S， Magas L， et al. Suspected chronic pancre-atitis with normal MRCP：findings on MRI in correlation withsecretin MRCP[J]. J Magn Reson Imaging， 2008， 27(1)：125-131.
25. Alkaade S， Cem Balci N， Momtahen AJ， et al. Normal pancreatic exocrine function does not exclude MRI/MRCP chronic pancreatitis findings[J]. J Clin Gastroenterol， 2008， 42(8)：950-955.
26. Balci NC， Bieneman BK， Bilgin M， et al. Magnetic resonance imaging in pancreatitis[J]. Top Magn Reson Imaging， 2009， 20(1)：25-30.
27. Bilgin M， Bilgin S， Balci NC， et al. Magnetic resonance imagingand magnetic resonance cholangiopancreatography findings compared with fecal elastase 1 measurement for the diagnosis of chronic pancreatitis[J]. Pancreas， 2008， 36(1)：e33-e39.
28. Sugiyama M， Haradome H， Atomi Y. Magnetic resonanceimaging for diagnosing chronic pancreatitis[J]. J Gastroenterol， 2007， 42 Suppl 17：108-112.
29. Zuccaro P， Stevens T， Repas K， et al. Magnetic resonance cholangiopancreatography reports in the evaluation of chronic pancreatitis：a need for quality improvement[J]. Pancreatology， 2009， 9(6)：764-769.
30. Sainani NI， Conwell DL. Secretin-enhanced MRCP：proceed with cautious optimism[J]. Am J Gastroenterol， 2009， 104(7)：1787-1789.

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