The utility of secretin-enhanced MRCP in diagnosing congenital anomalies

Kumar Sandrasegaran, Gregory A. Cote, Bilal Tahir, Iftikhar Ahmad, Mark Tann, M. Akisik, Chandana G. Lall, Stuart Sherman

Research output: Contribution to journalArticle

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Abstract

Purpose: To assess the additional value of secretin-enhanced MRCP (SMRCP) over conventional MRCP in diagnosing divisum.

Methods: Retrospective HIPAA-compliant and IRB-approved review found 140 patients with SMRCP and ERCP correlation within 6 months of each other. All studies were anonymized and the SMRCP images (SMRCP image set) were separated from 2D and 3D MRCP and axial and coronal T2-weighted images (conventional MRI image set). Each image set on each patient was assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete divisum vs. incomplete divisum, and the certainty of diagnosis (1 = definitely certain, 2 = moderately certain, and 3 = unsure). ERCP findings were taken as gold standard.

Results: There was no difference in age and gender between the divisum (n = 97, with 13 incomplete divisum) and no divisum (n = 43) groups. In diagnosing divisum anatomy, the sensitivity was higher for SMRCP compared to conventional MRI for R1 (84.5 vs. 72.2, p = 0.02) but not R2 (89.7 vs. 84.4, p = 0.25). The specificity was higher in SMRCP image set compared to conventional MRI (R1: 88.1 vs. 76.2, p = 0.01; R2: 81.4 vs. 65.1, p < 0.001). The mean area under ROC curve was higher for SMRCP image set (R1: 0.86 vs. 0.74, p = 0.01; R2: 0.87 vs. 0.74, p = 0.01). The certainty of diagnosis was higher in SMRCP image set compared to conventional MRI (p = 0.02 for both reviewers). SMRCP was not found to be superior in distinguishing incomplete from complete divisum. The main reasons for erroneous SMRCP diagnosis were the presence of an ansa loop in the main duct and ductal strictures due to chronic pancreatitis.

Conclusion: Even though the reviewers had more sequences (axial and coronal) to evaluate in the non-secretin image set, there was some improvement in diagnosing divisum with SMRCP.

Original languageEnglish
Pages (from-to)979-987
Number of pages9
JournalAbdominal Imaging
Volume39
Issue number5
DOIs
StatePublished - 2014

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Secretin
Endoscopic Retrograde Cholangiopancreatography
Health Insurance Portability and Accountability Act
Research Ethics Committees
Chronic Pancreatitis
ROC Curve
Area Under Curve
Anatomy
Pathologic Constriction

Keywords

  • Divisum
  • MRCP
  • Pancreatic anatomy
  • Secretin

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Medicine(all)

Cite this

The utility of secretin-enhanced MRCP in diagnosing congenital anomalies. / Sandrasegaran, Kumar; Cote, Gregory A.; Tahir, Bilal; Ahmad, Iftikhar; Tann, Mark; Akisik, M.; Lall, Chandana G.; Sherman, Stuart.

In: Abdominal Imaging, Vol. 39, No. 5, 2014, p. 979-987.

Research output: Contribution to journalArticle

Sandrasegaran, Kumar ; Cote, Gregory A. ; Tahir, Bilal ; Ahmad, Iftikhar ; Tann, Mark ; Akisik, M. ; Lall, Chandana G. ; Sherman, Stuart. / The utility of secretin-enhanced MRCP in diagnosing congenital anomalies. In: Abdominal Imaging. 2014 ; Vol. 39, No. 5. pp. 979-987.
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AU - Lall, Chandana G.

AU - Sherman, Stuart

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N2 - Purpose: To assess the additional value of secretin-enhanced MRCP (SMRCP) over conventional MRCP in diagnosing divisum.Methods: Retrospective HIPAA-compliant and IRB-approved review found 140 patients with SMRCP and ERCP correlation within 6 months of each other. All studies were anonymized and the SMRCP images (SMRCP image set) were separated from 2D and 3D MRCP and axial and coronal T2-weighted images (conventional MRI image set). Each image set on each patient was assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete divisum vs. incomplete divisum, and the certainty of diagnosis (1 = definitely certain, 2 = moderately certain, and 3 = unsure). ERCP findings were taken as gold standard.Results: There was no difference in age and gender between the divisum (n = 97, with 13 incomplete divisum) and no divisum (n = 43) groups. In diagnosing divisum anatomy, the sensitivity was higher for SMRCP compared to conventional MRI for R1 (84.5 vs. 72.2, p = 0.02) but not R2 (89.7 vs. 84.4, p = 0.25). The specificity was higher in SMRCP image set compared to conventional MRI (R1: 88.1 vs. 76.2, p = 0.01; R2: 81.4 vs. 65.1, p < 0.001). The mean area under ROC curve was higher for SMRCP image set (R1: 0.86 vs. 0.74, p = 0.01; R2: 0.87 vs. 0.74, p = 0.01). The certainty of diagnosis was higher in SMRCP image set compared to conventional MRI (p = 0.02 for both reviewers). SMRCP was not found to be superior in distinguishing incomplete from complete divisum. The main reasons for erroneous SMRCP diagnosis were the presence of an ansa loop in the main duct and ductal strictures due to chronic pancreatitis.Conclusion: Even though the reviewers had more sequences (axial and coronal) to evaluate in the non-secretin image set, there was some improvement in diagnosing divisum with SMRCP.

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