Diagnosis of Duct Disruption and Assessment of Pancreatic Leak with Dynamic Secretin-Stimulated MR Cholangiopancreatography
A. R. Gillams1,
T. Kurzawinski2 and
W. R. Lees1
1 Department of Medical Imaging, The Middlesex Hospital and University College
London Medical School, Mortimer St., London W1T 3AA, England.
2 Department of Surgery, The Middlesex Hospital and University College London
Medical School, London, England.
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Fig. 1A —14-year-old boy who sustained blunt trauma to abdomen. Axial TRUFISP
and coronal MR cholangiopancreatography images obtained using fast imaging
with steady-state precession sequence before (A and B) and after
(C and D) secretin. Collection increases in head of pancreas
(arrows) after secretin, indicating continuing duct disruption. Also
seen are free fluid around liver and increase in duodenal fluid content after
secretin administration.
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Fig. 1B —14-year-old boy who sustained blunt trauma to abdomen. Axial TRUFISP
and coronal MR cholangiopancreatography images obtained using fast imaging
with steady-state precession sequence before (A and B) and after
(C and D) secretin. Collection increases in head of pancreas
(arrows) after secretin, indicating continuing duct disruption. Also
seen are free fluid around liver and increase in duodenal fluid content after
secretin administration.
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Fig. 1C —14-year-old boy who sustained blunt trauma to abdomen. Axial TRUFISP
and coronal MR cholangiopancreatography images obtained using fast imaging
with steady-state precession sequence before (A and B) and after
(C and D) secretin. Collection increases in head of pancreas
(arrows) after secretin, indicating continuing duct disruption. Also
seen are free fluid around liver and increase in duodenal fluid content after
secretin administration.
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Fig. 1D —14-year-old boy who sustained blunt trauma to abdomen. Axial TRUFISP
and coronal MR cholangiopancreatography images obtained using fast imaging
with steady-state precession sequence before (A and B) and after
(C and D) secretin. Collection increases in head of pancreas
(arrows) after secretin, indicating continuing duct disruption. Also
seen are free fluid around liver and increase in duodenal fluid content after
secretin administration.
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Fig. 2A —49-year-old man with acute pancreatitis complicated by development
of collection that was drained via transgastric route but failed to resolve.
Coronal TRUFISP obtained using fast imaging with steady-state precession
sequence shows mixed-signal-intensity collection in body of pancreas
(black arrow). Normal duct is present in head and neck (white
arrow).
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Fig. 2B —49-year-old man with acute pancreatitis complicated by development
of collection that was drained via transgastric route but failed to resolve.
Axial T1-weighted image shows collection in body of pancreas (arrow),
with parenchyma of normal signal intensity in tail.
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Fig. 2C —49-year-old man with acute pancreatitis complicated by development
of collection that was drained via transgastric route but failed to resolve.
Sequential maximum intensity projections before secretin (C) and 3
(D) and 7 (E) min after secretin administration. Fluid signal
intensity increases in pancreatic collection (arrows) after secretin,
indicating continuing duct disruption and communication with cyst. Duct in
tail is mildly dilated before secretin administration and dilates further
after secretin administration.
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Fig. 2D —49-year-old man with acute pancreatitis complicated by development
of collection that was drained via transgastric route but failed to resolve.
Sequential maximum intensity projections before secretin (C) and 3
(D) and 7 (E) min after secretin administration. Fluid signal
intensity increases in pancreatic collection (arrows) after secretin,
indicating continuing duct disruption and communication with cyst. Duct in
tail is mildly dilated before secretin administration and dilates further
after secretin administration.
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Fig. 2E —49-year-old man with acute pancreatitis complicated by development
of collection that was drained via transgastric route but failed to resolve.
Sequential maximum intensity projections before secretin (C) and 3
(D) and 7 (E) min after secretin administration. Fluid signal
intensity increases in pancreatic collection (arrows) after secretin,
indicating continuing duct disruption and communication with cyst. Duct in
tail is mildly dilated before secretin administration and dilates further
after secretin administration.
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Fig. 3A —39-year-old woman, referred from another hospital, with
retroperitoneal collection that had developed after ERCP. Axial T1-weighted
image shows right-sided mixed-signal-intensity collection in retroperitoneum
(arrow).
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Fig. 3B —39-year-old woman, referred from another hospital, with
retroperitoneal collection that had developed after ERCP. Baseline MR
cholangiopancreatography (MRCP) image before secretin administration shows
anatomic variant with dorsal duct predominantly draining via accessory papilla
(solid arrow) and relatively small duct of Wirsung (dashed
arrow).
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Fig. 3C —39-year-old woman, referred from another hospital, with
retroperitoneal collection that had developed after ERCP. Sequential MRCP
sequences after secretin administration show fluid leaking from duct of
Wirsung (arrows).
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Fig. 3D —39-year-old woman, referred from another hospital, with
retroperitoneal collection that had developed after ERCP. Sequential MRCP
sequences after secretin administration show fluid leaking from duct of
Wirsung (arrows).
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Fig. 3E —39-year-old woman, referred from another hospital, with
retroperitoneal collection that had developed after ERCP. Secretin MRCP
repeated after 3 weeks of pancreatic rest with total parenteral nutrition and
percutaneous drainage of retroperitoneal fluid collection. Duct no longer
shows leakage (arrow). Abnormal dilatation of dorsal duct indicates
inadequate drainage from accessory papilla—that is, functional
obstruction in forme fruste divisum.
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Fig. 4A —24-year-old man who sustained blunt abdominal trauma. Axial
contrast-enhanced CT scan shows fluid collection (arrow) around
superior mesenteric vessels and extending into anterior abdomen.
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Fig. 4B —24-year-old man who sustained blunt abdominal trauma. Maximum
intensity projections of MRCP sequence before (B) and after (C)
secretin administration. Fluid content of duodenum, including duodenal cap
(arrows), increases, but no fluid leak from pancreatic duct is
present.
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Fig. 4C —24-year-old man who sustained blunt abdominal trauma. Maximum
intensity projections of MRCP sequence before (B) and after (C)
secretin administration. Fluid content of duodenum, including duodenal cap
(arrows), increases, but no fluid leak from pancreatic duct is
present.
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Copyright © 2006 by the American Roentgen Ray Society.
