Jejunal Response to Secretin is Independent of the Pancreatic Response in Secretin-Enhanced Magnetic Resonance Cholangiopancreatography

Publication date: Available online 3 January 2019

Source: European Journal of Radiology

Author(s): Nima Hafezi-Nejad, Vikesh K. Singh, Mahya Faghih, Ihab Kamel, Atif Zaheer

ABSTRACT

Purpose

To investigate whether jejunal secretions are independent of the pancreatic response to secretin in secretin-enhanced Magnetic Resonance Cholangiopancreatography (s-MRCP) examination of subjects with and without chronic pancreatitis (CP).

Methods

Patients were identified through a search of s-MRCP examinations performed between 2014-2016 (n = 513) as well as the multidisciplinary pancreatitis clinic registry (n = 586). Fifty cases with CP (based on M-ANNHEIM criteria) and 50 matched controls were selected. Signal intensity changes after secretin administration (˜1–5 minutes' post-secretin response) in three locations were assessed: second portion of the duodenum (D2), third/fourth portions of the duodenum (D3-4), and the jejunum. The post-secretin response was compared between (cases vs. controls) and within the study groups.

Results

There was a significantly lower 1–5 minutes' post-secretin response among CP patients in D2 (all p-values <0.01). However, no significant difference in 1–5 minutes' post-secretin response was detected in the jejunum. Minute-by-minute analysis of the post-secretin response showed a significant increase up to the 5^th minute only in D2 of the control group. The post-secretin response in the jejunum was significant after 1 minute but was similar among patients with CP and controls. CP was a significant determinant of post-secretin response in D2 but not in the jejunum.

Conclusions

Early post-secretin response at jejunum is independent of the pancreatic response that can be detected at D2, and should not be misinterpreted as a rapid pancreatic response. Therefore, pancreatic function on s-MRCP should be assessed by the presence of fluid in D2 and not jejunum.

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