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Pancreatic Duct After Pancreatoduodenectomy: Morphologic and Functional Evaluation with Secretin-Stimulated MR Pancreatography

¹ Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret 167, Barcelona 08025, Spain.
² Department of Radiology, Diagnosis Médica, Barcelona, Spain.
³ Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁴ Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

View larger version (103K): [in a new window]   Fig. 1. —Asymptomatic 56-year-old man 4 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 10 min after secretin injection shows normal pancreatic duct morphology and filling of more than first two jejunal loops (grade 3).

View larger version (97K): [in a new window]   Fig. 2A. —Asymptomatic 68-year-old man 2 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained before secretin administration reveals only proximal segment of main pancreatic duct (arrows), with marked irregularity and dilatation of side branches.

View larger version (84K): [in a new window]   Fig. 2B. —Asymptomatic 68-year-old man 2 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 3 min after secretin administration shows all segments of main pancreatic duct (arrows).

View larger version (83K): [in a new window]   Fig. 3A. —72-year-old man with pancreatic exocrine insufficiency 3 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained before secretin administration shows dilated proximal main pancreatic duct (arrow). Distal main pancreatic duct is seen with difficulty.

View larger version (93K): [in a new window]   Fig. 3B. —72-year-old man with pancreatic exocrine insufficiency 3 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 3 min after secretin injection reveals stricture (arrows) in mid portion of the main pancreatic duct with diffuse ductal irregularities and side branch dilatation in tail portion.

View larger version (78K): [in a new window]   Fig. 4A. —61-year-old woman with normal pancreatic exocrine function 2 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained before secretin administration shows dilated main pancreatic duct and side branches; only short segment of main pancreatic duct (arrow) is not visualized.

View larger version (87K): [in a new window]   Fig. 4B. —61-year-old woman with normal pancreatic exocrine function 2 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 3 min after secretin injection shows complete filling of main pancreatic duct (arrow), ruling out possible diagnosis of ductal stricture. Note improved visualization of side branches.

View larger version (84K): [in a new window]   Fig. 5A. —66-year-old man with pancreatic exocrine insufficiency 2 years after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained before secretin administration shows irregularity of main pancreatic duct.

View larger version (91K): [in a new window]   Fig. 5B. —66-year-old man with pancreatic exocrine insufficiency 2 years after pancreatoduodenectomy. On oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 2 min after secretin administration, patency of anastomotic site (arrows) could be confirmed visually.

View larger version (89K): [in a new window]   Fig. 6A. —71-year-old woman with recurrent abdominal pain 6 months after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained before secretin administration shows dilated and irregular main pancreatic duct.

View larger version (92K): [in a new window]   Fig. 6B. —71-year-old woman with recurrent abdominal pain 6 months after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 6 min after secretin administration reveals diffuse parenchymal enhancement on each side of duct (acinar filling).

View larger version (85K): [in a new window]   Fig. 6C. —71-year-old woman with recurrent abdominal pain 6 months after pancreatoduodenectomy. Oblique coronal heavily T2-weighted single-shot fast spin-echo MR pancreatogram obtained 10 min after secretin administration shows persistent dilatation of main pancreatic duct and parenchymal enhancement. Jejunal filling is reduced and is limited to anastomotic loop (grade 1), which likely indicates impaired pancreatic exocrine function.

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