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Dynamic MR Pancreatography After Secretin Administration: Image Quality and Diagnostic Accuracy

Karin J. Hellerhoff1, Hermann Helmberger, III1, Thomas Rösch2, Marcus R. Settles1, Thomas M. Link1 and Ernst J. Rummeny1

1 Department of Diagnostic Radiology, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, D-81675 München, Germany.
2 Department of Internal Medicine, Technische Universität München, Klinikum rechts der Isar, D-81675 München, Germany.



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  		Fig. 2C. —52-year-old woman with history of chronic pancreatitis presented with cholestasis and recurrent increase of pancreatic enzyme levels. T2-weighted single-slice fast spin-echo MR pancreatogram obtained 3 min after secretin administration shows improved side branch visualization in corpus portion of duct (arrowheads) and fluid-filled duodenal bulb.

 


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  		Fig. 1A. —59-year-old man with recurrent increase of pancreatic enzyme levels. Oblique coronal MR pancreatogram obtained using T2-weighted single-slice fast spin-echo sequence (TR/TE, 2432/800) shows normal pancreatic ductal morphology before secretin administration.

 


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  		Fig. 1B. —59-year-old man with recurrent increase of pancreatic enzyme levels. Oblique coronal MR pancreatogram obtained 2 min 30 sec after secretin injection reveals improved visualization of tail portion of main pancreatic duct and accessory duct (arrow). Bulb of duodenum is already filled with pancreatic juice (arrowhead).

 


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  		Fig. 1C. —59-year-old man with recurrent increase of pancreatic enzyme levels. Oblique coronal MR pancreatogram obtained 5 min 30 sec after secretin injection shows complete duodenal filling (arrowheads).

 


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  		Fig. 2A. —52-year-old woman with history of chronic pancreatitis presented with cholestasis and recurrent increase of pancreatic enzyme levels. T2-weighted single-slice fast spin-echo MR pancreatogram obtained before secretin administration reveals distal common bile duct stenosis (arrow) with consequent dilatation of intra- and extrahepatic bile ducts. Head portion of pancreatic duct is only slightly dilated.

 


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  		Fig. 2B. —52-year-old woman with history of chronic pancreatitis presented with cholestasis and recurrent increase of pancreatic enzyme levels. T2-weighted single-slice fast spin-echo MR pancreatogram obtained 2 min after secretin administration shows increasing diameter of pancreatic duct. Compared with A, there is improved visualization of pancreatic ductal irregularities (arrows) in head and corpus portion and of duct narrowing in tail portion with slight prestenotic dilatation.

 


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  		Fig. 3A. —37-year-old man with postprandial upper abdominal pain. Coronal single-slice T2-weighted MR image shows that pancreatic duct is difficult to see before secretin application.

 


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  		Fig. 3B. —37-year-old man with postprandial upper abdominal pain. Coronal single-slice T2-weighted MR image after secretin injection shows complete duct and substantial increase in diameter of duct, up to 5 mm, indicating papillary obstruction. Dynamic series allows identification of both major papilla (arrow) and minor papilla (arrowhead).

 


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  		Fig. 4A. —48-year-old man with history of chronic pancreatitis. MR pancreatogram before secretin administration does not allow complete visualization of tail portion of duct. Prepapillary region is not sufficiently depicted.

 


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  		Fig. 4B. —48-year-old man with history of chronic pancreatitis. MR pancreatogram after secretin administration reveals improved visualization of stricture with prestenotic dilatation in head portion (arrow) and diffuse ductal irregularities in tail portion (arrowheads).

 


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  		Fig. 4C. —48-year-old man with history of chronic pancreatitis. Endoscopic retrograde pancreatogram confirmed both stricture (arrow) and ductal irregularities (arrowheads) found on MR cholangiopancreatography. However, stricture was considered not significant enough to require endoscopic therapy.

 

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