Noninvasively evaluate pancreatic exocrine function using 2D cine-dynamic MRCP under physiological conditions: A preliminary study

Share this content in WeChat

• Clinical Article •

WU Qiaoling WANG Yun SUN Zhaoyong HU Geli WANG Yiming JIN Zhengyu XUE Huadan

WU Q L, WANG Y, SUN Z Y, et al. Noninvasively evaluate pancreatic exocrine function using 2D cine-dynamic MRCP under physiological conditions: A preliminary study[J]. Chin J Magn Reson Imaging, 2023, 14(9): 81-85. DOI:10.12015/issn.1674-8034.2023.09.014.

Abstract

[Abstract] Objective To explore the feasibility of using two-dimensional magnetic resonance cholangiopancreatography (2D-MRCP) dynamic cine imaging sequence to quantitatively detect changes in physiological pancreatic juice secretion in the main pancreatic duct of healthy volunteers after consuming a fat meal.Materials and Methods Thirty-six healthy volunteers were recruited, all of whom underwent 2D-MRCP film sequence scanning. Each movie sequence selects the pancreatic head layer and applies a 20 mm wide spatial selection inversion pulse (IR) saturation band at the pancreatic head position. Single layer breath-holding scan, with a breath-holding duration of 5 s and a breath-holding interval of 15 s. Collect and measure the frequency and length of pancreatic juice secretion (basic state frequency and length) of the volunteer 20 times before the fat meal, and hold the breath 60 times after the fat meal to observe the dynamic changes in pancreatic juice secretion after the fat meal. Compare the changes in pancreatic secretion length before and after a fat meal using paired t-tests, and compare the percentage increase in pancreatic secretion frequency after a fat meal compared to the base frequency. Volunteers were divided into three groups based on age. The first group was ≤ 30 years old, the second group was > 30 years old and ≤ 60 years old, and the third group was > 60 years old. The Kruskal Wallis method was used to compare the average frequency of pancreatic juice secretion after a fat meal, and the relationship between the average length and age.Results The frequency of pancreatic juice secretion before fat meal was 21.32%±1.20%, and the frequency of pancreatic juice secretion after fat meal was 29.82%±1.11%, an increase of 8.50%, with a statistical difference of P＜0.001. The length of pancreatic juice secretion before the fat meal was (11.06±7.27) mm, and the length of pancreatic juice secretion after the fat meal was (15.34±4.61) mm, with an average increase of 4.28 mm, showing a statistical difference of P=0.004. According to age group, there were statistical differences in the average frequency and length of pancreatic juice between the first group and the second and third groups, P＜0.001; There was no statistically significant difference in the average frequency and length of pancreatic juice between the second and third groups, with P-values of 0.477 and 0.316, respectively.Conclusions The 2D-MRCP dynamic movie sequence can quantitatively detect changes in pancreatic juice secretion flow after a fat meal, and this sequence has clinical value for non-invasive evaluation of pancreatic exocrine function under physiological conditions. The secretion function of pancreatic juice after fat meal may decrease with age.

[Keywords] pancreas；pancreatic exocrine eunction；pancreatic secretion frequency；pancreatic secretion length；fatty meal；cine-dynamic sequence；magnetic resonance cholangiopancreatography；magnetic resonance imaging

Contributor Information

WU Qiaoling¹ WANG Yun¹ SUN Zhaoyong¹ HU Geli² WANG Yiming² JIN Zhengyu¹ XUE Huadan^1*

¹ Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

² Philips (China) Investment Company Beijing Branch, Bejing 100600, China

Corresponding author: Xue HD, E-mail: bjdanna95@163.com

Conflicts of interest None.

Publication Information

ACKNOWLEDGMENTS National High Level Hospital Clinical Research (No. 2022-PUMCH-B-069).

Received 2023-04-06

Accepted 2023-08-09

DOI: 10.12015/issn.1674-8034.2023.09.014

Text

References

[1]

LAN X Y, ROBIN G, KASNIK J, et al. Challenges in diagnosis and treatment of pancreatic exocrine insufficiency among patients with pancreatic ductal adenocarcinoma[J/OL]. Cancers, 2023, 15(4): 1331 [2023-07-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9953920. DOI: 10.3390/cancers15041331.

[2]

Study Group of Pancreatic Surgery in Chinese Society of Surgery of Chinese Medical Association, Pancreatic Disease Committee of Chinese Research Hospital Association. A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency after pancreatic surgery (2018)[J]. Chin J Surg, 2018, 56(9): 641-645. DOI: 10.3760/cma.j.issn.0529-5815.2018.09.001.

[3]

ZHANG Y H, CUI N Q. Diagnosis and treatment of pancreatic exocrine insufficiency in chronic pancreatitis[J]. Chin J Surg Integr Tradit West Med, 2018, 24(6): 789-792. DOI: 10.3969/j.issn.1007-6948.2018.06.027.

[4]

HOPSON P, SMADI Y, MEHTA V, et al. Assessment of exocrine pancreatic function in children and adolescents with direct and indirect testing[J/OL]. Front Pediatr, 2022, 10: 908542 [2023-07-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9704773. DOI: 10.3389/fped.2022.908542.

[5]

FERNANDEZ J, HOPSON P, PATEL S B, et al. Prevalence of exocrine pancreatic dysfunction based on direct function testing in pediatric inflammatory bowel disease[J]. J Pediatr Gastroenterol Nutr, 2023, 76(4): 475-479. DOI: 10.1097/MPG.0000000000003725.

[6]

KOTHARI D, KETWAROO G, SAWHNEY M S, et al. Comparison of combined endoscopic ultrasonography and endoscopic secretin testing with the traditional secretin pancreatic function test in patients with suspected chronic pancreatitis: a prospective crossover study[J]. Pancreas, 2017, 46(6): 770-775. DOI: 10.1097/MPA.0000000000000829.

[7]

MONACHESE M, LEE P J, HARRIS K, et al. EUS and secretin endoscopic pancreatic function test predict evolution to overt structural changes of chronic pancreatitis in patients with nondiagnostic baseline imaging[J]. Endosc Ultrasound, 2021, 10(2): 116-123. DOI: 10.4103/EUS-D-20-00138.

[8]

WU D Q, WANG X P. Clinical value and significance of indirect determination of pancreatic exocrine function[J]. J Chin Pract Diagn Ther, 2008, 22(12): 927-929. DOI: 10.3969/j.issn.1674-3474.2008.12.019.

[9]

GONZÁLEZ-SÁNCHEZ V, AMRANI R, GONZÁLEZ V, et al. Diagnosis of exocrine pancreatic insufficiency in chronic pancreatitis: 13C-Mixed Triglyceride Breath Test versus Fecal Elastase[J]. Pancreatology, 2017, 17(4): 580-585. DOI: 10.1016/j.pan.2017.03.002.

[10]

GOPI S, SINGH N, YEGURLA J, et al. Utility of Fecal Elastase-1 to diagnose severe exocrine insufficiency in chronic pancreatitis: real world experience[J]. Pancreatology, 2023, 23(2): 151-157. DOI: 10.1016/j.pan.2023.01.002.

[11]

LINDKVIST B, PHILLIPS M E, DOMÍNGUEZ-MUÑOZ J E. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: prevalence and diagnostic use[J]. Pancreatology, 2015, 15(6): 589-597. DOI: 10.1016/j.pan.2015.07.001.

[12]

HARDT P D, MARZEION A M, SCHNELL-KRETSCHMER H, et al. Fecal elastase 1 measurement compared with endoscopic retrograde cholangiopancreatography for the diagnosis of chronic pancreatitis[J/OL]. Pancreas, 2002, 25(1): e6-e9 [2023-07-19]. https://journals.lww.com/pancreasjournal/abstract/2002/07000/fecal_elastase_1_measurement_compared_with.4.aspx. DOI: 10.1097/00006676-200207000-00004.

[13]

ITO K, TORIGOE T, TAMADA T, et al. The secretory flow of pancreatic juice in the main pancreatic duct: visualization by means of MRCP with spatially selective inversion-recovery pulse[J]. Radiology, 2011, 261(2): 582-586. DOI: 10.1148/radiol.11110162.

[14]

MANFREDI R, MUCELLI R P. Secretin-enhanced MR imaging of the pancreas[J]. Radiology, 2016, 279(1): 29-43. DOI: 10.1148/radiol.2015140622.

[15]

ENGJOM T, TJORA E, ERCHINGER F, et al. Secretin-stimulated magnetic resonance imaging reveals variable diagnostic accuracy according to etiology in pancreatic disease[J]. Pancreas, 2020, 49(3): 361-367. DOI: 10.1097/MPA.0000000000001491.

[16]

YASOKAWA K, ITO K, TAMADA T, et al. Postprandial changes in secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP with a spatially selective inversion-recovery (IR) pulse[J]. Eur Radiol, 2016, 26(12): 4339-4344. DOI: 10.1007/s00330-016-4287-5.

[17]

CHAMOKOVA B, BASTATI N, POETTER-LANG S, et al. The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases[J/OL]. Br J Radiol, 2018, 91(1084): 20170677 [2023-07-19]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5966000. DOI: 10.1259/bjr.20170677.

[18]

SANDRASEGARAN K, TAHIR B, BARAD U, et al. The value of secretin-enhanced MRCP in patients with recurrent acute pancreatitis[J]. AJR Am J Roentgenol, 2017, 208(2): 315-321. DOI: 10.2214/AJR.16.16566.

[19]

SWENSSON J, ZAHEER A, CONWELL D, et al. Secretin-enhanced MRCP: how and why-AJR expert panel narrative review[J]. AJR Am J Roentgenol, 2021, 216(5): 1139-1149. DOI: 10.2214/AJR.20.24857.

[20]

GULLO L, PRIORI P, PEZZILLI R, et al. Pancreatic secretory response to ordinary meals: studies with pure pancreatic juice[J]. Gastroenterology, 1988, 94(2): 428-433. DOI: 10.1016/0016-5085(88)90432-5.

[21]

HAYAKAWA T, KATADA N, KONDO T, et al. Meal-stimulated cholecystokinin release and exocrine pancreatic secretion in dogs[J]. Res Exp Med, 1988, 188(1): 19-25. DOI: 10.1007/BF01852090.

[22]

YASOKAWA K, ITO K, KANKI A, et al. Evaluation of pancreatic exocrine insufficiency by cine-dynamic MRCP using spatially selective inversion-recovery (IR) pulse: correlation with severity of chronic pancreatitis based on morphological changes of pancreatic duct[J]. Magn Reson Imaging, 2018, 48: 70-73. DOI: 10.1016/j.mri.2017.12.007.

[23]

CEYLAN S, YILMAZ N. Evaluation of dyspepsia with optimal and suboptimal gastric emptying tests in patients with euthyroid goiter[J]. Curr Med Imaging, 2023, 19(14): 1665-1674. DOI: 10.2174/1573405619666230209123957.

[24]

WANG X J, BURTON D D, BREEN-LYLES M, et al. Gastric accommodation influences proximal gastric and total gastric emptying in concurrent measurements conducted in healthy volunteers[J]. Am J Physiol Gastrointest Liver Physiol, 2021, 320(5): G759-G767. DOI: 10.1152/ajpgi.00008.2021.

[25]

MALAGELADA J R, GO V L, SUMMERSKILL W H. Different gastric, pancreatic, and biliary responses to solid-liquid or homogenized meals[J]. Dig Dis Sci, 1979, 24(2): 101-110. DOI: 10.1007/BF01324736.

[26]

TORIGOE T, ITO K, YAMAMOTO A, et al. Age-related change of the secretory flow of pancreatic juice in the main pancreatic duct: evaluation with cine-dynamic MRCP using spatially selective inversion recovery pulse[J]. AJR Am J Roentgenol, 2014, 202(5): 1022-1026. DOI: 10.2214/AJR.13.10852.

[27]

FUTAGAMI S, KESSOKU T, KASAI Y, et al. Comparison of clinical characteristics, eating behaviors, and clinical symptoms following fat intake in functional dyspepsia with functional dyspepsia with pancreatic enzyme abnormalities between Singapore and Japan[J]. J Gastroenterol Hepatol, 2022, 37(8): 1525-1533. DOI: 10.1111/jgh.15874.

PREV Correlation between radiomics features on T2WI sequences and clinical features of recurrent acute pancreatitis

NEXT Quantitative measurement of renal fat in patients with type 2 diabetes mellitus: Comparison between Dixon and HISTO MRS techniques

LINK

Tel & Fax: +8610-67113815 E-mail: editor@cjmri.cn