Assessment of chronic pancreatitis: Utility of diffusion-weighted MR imaging with secretin enhancement

M. Fatih Akisik, Alex M. Aisen, Kumar Sandrasegaran, S. Gregory Jennings, Chen Lin, Stuart Sherman, John A. Lin, Magnus Rydberg

Research output: Contribution to journalArticle

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Abstract

Purpose: To retrospectively measure and compare changes in pancreatic apparent diffusion coefficient (ADC) following secretin administration in patients with and those without chronic pancreatitis (CP) who underwent magnetic resonance (MR) cholangiopancreatography with diffusion-weighted (DW) imaging. Materials and Methods: This retrospective HIPAA-compliant study was approved by the authors' institutional review board, with waiver of informed consent. Eighty-nine patients were categorized by the referring gastroenterologist as having no CP (n = 37), mild CP (n = 33), or severe CP (n = 19) on the basis of Cambridge criteria and/or clinical course. Mean age was 52.2 years (range, 21-82 years) in women and 54.3 years (range, 32-81 years) in men. Patients underwent 1.5-T MR cholangiopancreatography, including DW sequences (b = 0, 100, and 400 sec/mm 2) performed serially for 10 minutes after secretin injection. Severity level of CP was analyzed for sex (Fisher exact test) and age (analysis of variance) differences. Pairwise comparisons of mean ADCs for each parameter (no CP vs mild CP, no CP vs severe CP, mild CP vs severe CP) were performed (Mann-Whitney test). Threshold values of non-secretin-enhanced ADC for pancreatitis discrimination were calculated with receiver operating characteristic analysis. P < .05 was considered to show a significant difference. Results: Patients with severe CP were more likely to be men than were those without pancreatitis; there were no significant age differences between groups. Mean nonenhanced and maximum secretin-enhanced ADCs were higher in patients without CP than in those with mild or severe CP but did not vary between those with mild and severe CP. Percentage increase in ADC after secretin injection and time to peak ADC did not vary among groups. An ADC of less than 179 × 10 -5 mm 2/sec was optimal for delineating normal pancreas from CP groups. Conclusion: In symptomatic patients, baseline pancreatic ADC obtained with DW imaging prior to secretin administration may aid in diagnosis of CP and assessment of its severity; ADC response to secretin administration may be less useful.

Original languageEnglish (US)
Pages (from-to)103-109
Number of pages7
JournalRadiology
Volume250
Issue number1
DOIs
StatePublished - Jan 1 2009

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Diffusion Magnetic Resonance Imaging
Secretin
Chronic Pancreatitis
Magnetic Resonance Cholangiopancreatography
Pancreatitis
Health Insurance Portability and Accountability Act
Injections
Research Ethics Committees

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Assessment of chronic pancreatitis : Utility of diffusion-weighted MR imaging with secretin enhancement. / Akisik, M. Fatih; Aisen, Alex M.; Sandrasegaran, Kumar; Jennings, S. Gregory; Lin, Chen; Sherman, Stuart; Lin, John A.; Rydberg, Magnus.

In: Radiology, Vol. 250, No. 1, 01.01.2009, p. 103-109.

Research output: Contribution to journalArticle

Akisik, M. Fatih ; Aisen, Alex M. ; Sandrasegaran, Kumar ; Jennings, S. Gregory ; Lin, Chen ; Sherman, Stuart ; Lin, John A. ; Rydberg, Magnus. / Assessment of chronic pancreatitis : Utility of diffusion-weighted MR imaging with secretin enhancement. In: Radiology. 2009 ; Vol. 250, No. 1. pp. 103-109.
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AU - Sandrasegaran, Kumar

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AU - Lin, Chen

AU - Sherman, Stuart

AU - Lin, John A.

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N2 - Purpose: To retrospectively measure and compare changes in pancreatic apparent diffusion coefficient (ADC) following secretin administration in patients with and those without chronic pancreatitis (CP) who underwent magnetic resonance (MR) cholangiopancreatography with diffusion-weighted (DW) imaging. Materials and Methods: This retrospective HIPAA-compliant study was approved by the authors' institutional review board, with waiver of informed consent. Eighty-nine patients were categorized by the referring gastroenterologist as having no CP (n = 37), mild CP (n = 33), or severe CP (n = 19) on the basis of Cambridge criteria and/or clinical course. Mean age was 52.2 years (range, 21-82 years) in women and 54.3 years (range, 32-81 years) in men. Patients underwent 1.5-T MR cholangiopancreatography, including DW sequences (b = 0, 100, and 400 sec/mm 2) performed serially for 10 minutes after secretin injection. Severity level of CP was analyzed for sex (Fisher exact test) and age (analysis of variance) differences. Pairwise comparisons of mean ADCs for each parameter (no CP vs mild CP, no CP vs severe CP, mild CP vs severe CP) were performed (Mann-Whitney test). Threshold values of non-secretin-enhanced ADC for pancreatitis discrimination were calculated with receiver operating characteristic analysis. P < .05 was considered to show a significant difference. Results: Patients with severe CP were more likely to be men than were those without pancreatitis; there were no significant age differences between groups. Mean nonenhanced and maximum secretin-enhanced ADCs were higher in patients without CP than in those with mild or severe CP but did not vary between those with mild and severe CP. Percentage increase in ADC after secretin injection and time to peak ADC did not vary among groups. An ADC of less than 179 × 10 -5 mm 2/sec was optimal for delineating normal pancreas from CP groups. Conclusion: In symptomatic patients, baseline pancreatic ADC obtained with DW imaging prior to secretin administration may aid in diagnosis of CP and assessment of its severity; ADC response to secretin administration may be less useful.

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