| Objective:1.To present a proposal for quantification of exocrine function using secretin-enhancedMRCP and fecal elastase1(FE-1) tests for the assesment of CP.2.To discuss the clinical application of the S-MRCP and Magnetic resonance enhancedimaging in evaluating the chronic pancreatitis.Methods:1. From April2011to January2013, The present study includes53subjectscomposed of17health volunteers (12men and5women; mean age,44±14.5years; agerange,24-64years; mean BMI24.6±3.4; BMI range,18.9-31.1),36patients with CP (23man and13women; mean age41±13.9years; age range,5-78years; mean BMI23.6±4.4; BMI range,15.4-34.7).36patients with CP were divided into three groups of mild CP(n=14), moderate CP (n=19) and advanced CP (n=3) by M-ANNHEIM criteria for CP.2. For the FE-1a single random stool sample was required with no need to stopenzyme supplements. Pancreatic exocrine reserve was determined in all patients using theFE-1test, and results were determined using sandwich enzyme-linked immunosorbentassay (ELISA) test, with two monoclonal antibodies that exclusively bind to humanelastase-1. A commercial kit was used (ScheBo. Tech, Germany) containing a humanelastase-specific antibody-sensitised ELISA plate. Elastase concentration was thendetermined by a photometric method. Then the FE-1values were separately score as1forFE-1>200μg/g, and0for FE-1<200μg/g.3.53cases have undergone T1-Weighted, T2-weighted, dynamic enhanced MR,MRCP and FE1. Coronal T2-weighted sequences and thick slab2D MRCP sequence wereperformed bfeore and at2min intervals after0.1mL/kg Secretin. A semiquantitativeS-MRCP grading for duodenal filling (DF) was used to preliminarily assess the exocrinefunction of the pancreas. By drawing an appropriate region of interest (ROI), Changes insignal intensity in the imaging volume were plotted against time and the flow rate derivedfrom the gradient. Pancreatic exocrine secretions were quantified by pancreatic flow output(PFR) and Peak Time (PT). Two single radiologists assessed pancreatic signal intensityratio (SIR) and arterial enhancement ratio (A/V) at head, body and tail of the pancreas on T1-weighted fat-suppressed and serial contrast-enhanced images at a single session.Combined findings were graded with a composite score.4. Statistical analyses were performed in SPSS20.0for Windows software. Datawere reported as the median or the mean±one standard deviation (SD). Then, difference,correlation and consistency between the groups were analyzed respectively.Results:1.In53cases, pancreas divisum was found in three patients, annular pancreas wasfound in two patients and gallbladder stones was found in two patients.2. The result of FE-1: The mean FE-1of17volunteers was525.4±97.4μg/g (range301.6-673.2μg/g). By M-ANNHEIM classification, the mean FE-1of32patients was464.95±136.13μg/g for mild CP,301.45±181.55μg/g for moderate CP,229.30±146.60μg/g for advanced CP. Furthermore, statistically significant difference in FE-1(P=0.0001)was observed between health and CP. The mean values of FE-1were453.64±162.74μg/gfor grade3;285.59±158.03μg/g for grade (1+2). However, statistically significantdifference in FE-1(P=0.002) was observed between grade3and grade (1+2).3. Semi-quantitative image analysis: Ten minutes after secretin administration,17volunteers and23/33patients showed a duodenal filling beyond the genu inferius (grade3);whereas8/36showed a duodenal filling up to the genu inferius (grade2);5/36showed aduodenal filling limited to the duodenal bulb (grade1), None of the patients showed absentfilling (grade0).4. Quantitative image analysis:. The mean PFR of17volunteers was8.2±1.11mL/min (range6.2-11mL/min). The mean PT was5.76±1.71min (range3-11min). ByM-ANNHEIM classification, the mean PFR and PT of32patients were7.27±2.04mL/min,7.86±2.80min for mild CP,4.89±2.57mL/min,9.00±2.89min for moderateCP,4.13±1.82mL/min,12.33±1.15min for advanced CP. Furthermore, statisticallysignificant difference in FPR (P=0.0001) and PT (P=0.0001) was observed between healthand CP.. The mean values of FPR and PT were7.16±2.34mL/min,7.28±2.56min forgrade3,285.59±158.03μg/g for grade (1+2). However, statistically significant differencein FPR (P=0.001) and PT (P=0.0001) was observed between grade3and grade (1+2)..Significant correlation was present between FPR and FE-1(r=0.79). It was related betweenM-ANNHEIM classification and PFR (r=0.55), FE-1(r=0.57).There were correlationsbetween DF grades and PFR (r=0.36), but not FE-1(r=0.29). 5. The result of signal rate:. After secretin administration, the visualization of allportions of the main pancreatic duct were significantly improved in all cases. However,delineation of side branches was rare in health adults and significantly improved only inpatients.. The mean values of SIR and A/V were1.21±0.19,1.16±0.11for healthy;1.10±0.19,1.13±0.26for mild CP;0.89±0.18,0.95±0.13for moderate CP;0.77±0.10,0.81±0.59for advanced CP. Furthermore, statistically significant difference in SIR(P=0.0001) and A/V (P=0.0001) was observed between health and CP..36patients withCP were divided into three groups of mild CP (n=11), moderate CP (n=12) and severe CP(n=13) by Cambridge classification for CP. The mean values of SIR and A/V were1.07±0.21,1.23±0.34for mild CP;0.98±0.21,0.97±0.16for moderate CP;0.85±0.18,0.91±0.12for severe CP. However, statistically significant difference in SIR (P=0.0001) andA/V (P=0.0001) was observed between health and chronic pancreatitis.. Ten minutesafter secretin administration, the mean values of SIR and A/V were1.09±0.20,1.15±0.11for grade3,0.88±0.27,0.94±0.30for grade (1+2). statistically significantdifferences in SIR (P=0.003) and A/V (P=0.046) were observed between grade3andgrade (1+2). It was related between M-ANNHEIM classification and SIR (r=0.67), A/V(r=0.56), and it was also related between Cambridge classification and SIR (r=0.60), A/V(r=0.60). There were correlations between DF grades and SIR (r=0.41), A/V (r=0.52).Conclusions:Semi-SMRCPQ can be used to preliminarily assess the exocrine function of thepancreas, SMRCPQ can accurately assess the exocrine function of the pancreas. S-MRCPcan provide a safe, non-invasive and efficient method to evaluate the exocrine function ofthe pancreas. S-MRCP combined with enhanced scanning can evaluate chronic pancreatitisin two aspects of morphology and function, which can provide a useful reference for theclinical treatment. |
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