Accuracy of magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum

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Abstract

Background: Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing pancreas divisum. Aim: To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution. Methods: We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. Results: ERP identified pancreas divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 pancreas divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3-25.3]). Summary: MRCP without secretin is non-diagnostic for pancreas divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting pancreas divisum. However, the sensitivity of S-MRCP for the diagnosis of pancreas divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.

Original languageEnglish
Pages (from-to)170-174
Number of pages5
JournalDigestive Diseases and Sciences
Volume57
Issue number1
DOIs
StatePublished - Jan 2012

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Magnetic Resonance Cholangiopancreatography
Pancreas
Secretin
Endoscopic Retrograde Cholangiopancreatography
Chronic Pancreatitis

Keywords

  • Endoscopic retrograde cholangiopancreatography
  • ERCP
  • Magnetic resonance cholangiopancreatography
  • MRCP
  • Pancreas
  • Secretin

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

@article{0696a8e2b1234f51b6446c56c99fba3e,
title = "Accuracy of magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum",
abstract = "Background: Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing pancreas divisum. Aim: To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution. Methods: We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2{\%}), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. Results: ERP identified pancreas divisum in 19/113 (16.8{\%}) patients. S-MRCP identified 14/19 pancreas divisum and was false-positive in three cases (sensitivity 73.3{\%}, specificity 96.8{\%}, positive predictive value 82.4{\%}, negative predictive value 94.8{\%}). Of the eight patients with inaccurate S-MRCP, 5 (63{\%}) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23{\%}) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95{\%} confidence interval (CI) 1.3-25.3]). Summary: MRCP without secretin is non-diagnostic for pancreas divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting pancreas divisum. However, the sensitivity of S-MRCP for the diagnosis of pancreas divisum was modest at 73.3{\%}. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100{\%}.",
keywords = "Endoscopic retrograde cholangiopancreatography, ERCP, Magnetic resonance cholangiopancreatography, MRCP, Pancreas, Secretin",
author = "Patrick Mosler and M. Akisik and Kumar Sandrasegaran and Evan Fogel and J. Watkins and W. Alazmi and Stuart Sherman and Glen Lehman and Thomas Imperiale and Lee McHenry",
year = "2012",
month = "1",
doi = "10.1007/s10620-011-1823-7",
language = "English",
volume = "57",
pages = "170--174",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "1",

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T1 - Accuracy of magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum

AU - Mosler, Patrick

AU - Akisik, M.

AU - Sandrasegaran, Kumar

AU - Fogel, Evan

AU - Watkins, J.

AU - Alazmi, W.

AU - Sherman, Stuart

AU - Lehman, Glen

AU - Imperiale, Thomas

AU - McHenry, Lee

PY - 2012/1

Y1 - 2012/1

N2 - Background: Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing pancreas divisum. Aim: To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution. Methods: We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. Results: ERP identified pancreas divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 pancreas divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3-25.3]). Summary: MRCP without secretin is non-diagnostic for pancreas divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting pancreas divisum. However, the sensitivity of S-MRCP for the diagnosis of pancreas divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.

AB - Background: Patients with pancreas divisum may develop pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for diagnosing pancreas divisum. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test reported to be highly accurate in diagnosing pancreas divisum. Aim: To evaluate the diagnostic accuracy of MRCP in detecting pancreas divisum at our institution. Methods: We reviewed patients who underwent both ERCP and MRCP. Patients who had diagnostic endoscopic pancreatograms (ERP) after MRCP comprise the study population. Secretin was given in 113/146 patients (S-MRCP). The remaining 33/146 patients had MRCP without secretin. In 7/33 patients who underwent MRCP without secretin (21.2%), the studies were non-diagnostic and, therefore, this group was not further analyzed and the study focused on the S-MRCP group only. Results: ERP identified pancreas divisum in 19/113 (16.8%) patients. S-MRCP identified 14/19 pancreas divisum and was false-positive in three cases (sensitivity 73.3%, specificity 96.8%, positive predictive value 82.4%, negative predictive value 94.8%). Of the eight patients with inaccurate S-MRCP, 5 (63%) had changes of chronic pancreatitis by ERP. This differs from the frequency of chronic pancreatitis by ERP in 24/105 (23%) patients with accurate MRCP findings. The ERCP findings of chronic pancreatitis were more frequent among incorrect S-MRCP interpretations than among correct interpretations (odds ratio [OR] 5.5 [95% confidence interval (CI) 1.3-25.3]). Summary: MRCP without secretin is non-diagnostic for pancreas divisum in a significant proportion of patients. S-MRCP had a satisfactory specificity for detecting pancreas divisum. However, the sensitivity of S-MRCP for the diagnosis of pancreas divisum was modest at 73.3%. This is low compared to previous smaller studies, which reported a sensitivity of MRCP of up to 100%.

KW - Endoscopic retrograde cholangiopancreatography

KW - ERCP

KW - Magnetic resonance cholangiopancreatography

KW - MRCP

KW - Pancreas

KW - Secretin

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U2 - 10.1007/s10620-011-1823-7

DO - 10.1007/s10620-011-1823-7

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JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

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