William Lea MD, Presenter: Nothing to Disclose

Kumaresan Sandrasegaran MD, Abstract Co-Author: Research grant, Siemens AG Consultant, Repligen Corporation

Bilal Tahir MD, Abstract Co-Author: Nothing to Disclose

Kavitha Nutakki MD, Abstract Co-Author: Nothing to Disclose

Rommel Singh Dhadha MD, Abstract Co-Author: Nothing to Disclose

Mark Tann MD, Abstract Co-Author: Nothing to Disclose

Alex M. Aisen MD, Abstract Co-Author: Consultant, Repligen Corporation Research grant, Repligen Corporation Consultant, Carestream Health, Inc

Lee McHenry MD, Abstract Co-Author: Nothing to Disclose

Fatih Mustafa Akisik MD, Abstract Co-Author: Nothing to Disclose

Stuart Sherman MD, Abstract Co-Author: Consultant, Repligen Corporation

To assess the additional value of secretin-enhanced MRCP over conventional MRCP in diagnosing congenital pancreatic ductal anomalies

Retrospective review found 140 patients with SMRCP and ERCP correlation within three months of each other. All studies were anonimized and the secretin-enhanced MRCP (group A) was separated from conventional 2D and 3D MRCP and T2-weighted images (group B). Groups A and B for each patient were assigned different and randomized case numbers. Two reviewers (R1 and R2) independently reviewed the image sets for divisum vs. no divisum, complete vs. incomplete divisum, and the certainty of diagnosis (1= definitely certain, 2 = moderately certain, 3 = unsure). ERCP findings were taken as gold standard.

There was no difference in age, sex or incidence of chronic pancreatitis between the divisum (n=97, with 13 incomplete divisum) and no divisum (n=43) groups. In diagnosing divisum anatomy, the sensitivity was higher in group A compared to B for reviewer 1 (83.5 vs. 74.2, p=0.02) but not reviewer 2 (87.6 vs. 85.6, p=0.24). The specificity was higher in group A compared to B for both reviewers (R1: 86.1 vs. 74.4, p=0.03, and R2 76.7 vs. 60.5, p=0.02). The % of definitely certain diagnosis was higher in group A, compared to group B, for both reviewers' (11.3 and 12.2%, p=0.08 and 0.07). In differentiating complete and incomplete divisum, the area-under ROC curve was higher for group A compared to group B for both reviewers (0.42 vs. 0.65, 0.49 vs. 0.62, both p < 0.01).

Even though the reviewers had more sequences (axial and coronal) to evaluate in the nonsecretin image set (group B), there was a significant improvement in diagnosing divisum, and differentiating complete and incomplete divisum with secretin-enhanced MRCP.

Consideration should be given to the routine use of secretin-enhanced MRCP. Improved diagnostic ability may obviate the need for diagnostic ERCP in some cases.

Lea, W, Sandrasegaran, K, Tahir, B, Nutakki, K, Dhadha, R, Tann, M, Aisen, A, McHenry, L, Akisik, F, Sherman, S, The Utility of Secretin-enhanced MRCP in Diagnosing Congenital Anomalies.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11008246.html