Symptoms that are associated with decreased pancreatic enzyme flow: MRCP assessment

Background

Pancreatic exocrine insufficiency is one of the causes of malabsorption syndrome. In many cases of malabsorption syndrome, pancreatic exocrine insufficiency can be treated with pancreatic enzyme replacement therapy. Therefore, it is important to detect pancreatic endocrine insufficiency as early and accurately as possible. Recent studies have shown that cine‐dynamic MR cholangiopancreatography (MRCP) may be useful to evaluate pancreatic exocrine function

Purpose

To identify abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion for which cine‐dynamic MRCP should be performed to diagnose pancreatic exocrine insufficiency.

Study Type

Prospective.

Population

In all, 111 patients with various types of abdominal symptoms.

Field Strength/Sequence

5 T or 3 T, MRCP with spatially selective inversion recovery pulse (cine‐dynamic MRCP).

Assessment

Cine‐dynamic MRCP was performed and an 18‐question clinical questionnaire on abdominal symptoms was administered. The secretion grade derived from cine‐dynamic MRCP was compared between those answering "yes" and "no" for all 18 items

Statistical Tests

Univariate analysis and further analyzed using multiple regression analysis. The associations between the secretion grade and the items in the clinical questionnaire were analyzed by univariate analysis and further analyzed using multiple regression analysis.

Results

The following three items showed significantly negative correlations with secretion grade: Q9, Does your rectal gas smell foul? (β = –0.44, P = 0.001); Q13, Is stool quantity large? (β = –0.41, P = 0.001); and Q18, Are your stools soft? (β = –0.53, P < 0.001). No significant correlations with exocrine pancreatic function measured by cine‐dynamic MRCP were seen for the remaining 15 abdominal symptom items.

Data Conclusion

Abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion were foul rectal gas, large stool, and soft stool. Pancreatic exocrine insufficiency due to decreased pancreatic enzyme flow may be suspected in patients with these abdominal symptoms.

Level of Evidence: 1

Technical Efficacy Stage: 3

J. Magn. Reson. Imaging 2019.

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