Neda Rastegar MD, Presenter: Nothing to Disclose

Luciana Athayde MD, Abstract Co-Author: Nothing to Disclose

John Eng MD, Abstract Co-Author: Nothing to Disclose

Naoki Takahashi MD, Abstract Co-Author: Nothing to Disclose

Eric P. Tamm MD, Abstract Co-Author: Nothing to Disclose

Koenraad J. Mortele MD, Abstract Co-Author: Nothing to Disclose

Sapna Syngal, Abstract Co-Author: Nothing to Disclose

Elliot K. Fishman MD, Abstract Co-Author: Research support, Siemens AG Advisory Board, Siemens AG Research support, General Electric Company Advisory Board, General Electric Company Co-founder, HipGraphics, Inc

Marcia Irene Canto MD, Abstract Co-Author: Nothing to Disclose

Ihab R. Kamel MD, PhD, Abstract Co-Author: Nothing to Disclose

Intraductal Papillary Mucinous Neoplasm (IPMN) is a precursor of invasive pancreatic cancer (PC) distinguished from other pancreatic cystic neoplasms by its communication with the pancreatic duct. Secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) has the potential to enhance the detection of ductal communication of pancreatic cysts. We investigated the incremental diagnostic yield of S-MRCP in a population with a high prevalence of small pancreatic cysts.  

Standard MRCP protocol was performed with and without secretin using 1.5 T magnets in subjects undergoing pancreatic screening because of a strong family history of pancreatic cancer as part of the multicenter trial. All studies were reviewed prospectively by two independent readers who recorded the presence and number of pancreatic cysts, the presence of visualized ductal communication before and after secretin, and the degree of confidence in the diagnoses. 

Of 202 individuals enrolled (mean age 56 years, 46% males), 93 (46%) had pancreatic cysts detected by MRCP, and 64 of the 93 had pre-and post-secretin MRCP images available for comparison. Data from the 128 readings show that 6 (6/128 = 4.7%) had ductal communication visualized only on the secretin studies compared to pre-secretin studies (odds ratio 1.28, p = 0.04). In addition, there was a statistically significant increase in confidence in reporting ductal communication after secretin compared to before secretin (p <0.0005).

At 1.5 T MRI, the use of secretin can improve the visualization of ductal communication of cystic pancreatic lesions. This incremental increase in visualizing ductal communication was also associated with increasing the reader’s confidence in making a diagnosis of IPMN. 

With 1.5 T MRI, the use of secretin improved visualization of ductal communication of a cystic pancreatic lesion in 4.6% of patients with cysts.  The incremental value of secretin in screening subjects for IPMN could potentially offset the added cost and time for additional sequences. Radiologists should decide on the cost/benefit ratio of using secretin in such cases.

Rastegar, N, Athayde, L, Eng, J, Takahashi, N, Tamm, E, Mortele, K, Syngal, S, Fishman, E, Canto, M, Kamel, I, Incremental Value of Secretin-Enhanced Magnetic Resonance Cholangiopancreatography in the Screening of Asymptomatic Individuals with High Risk of Pancreatic Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001797.html