Assessment of MRCP for the diagnosis of chronic pancreatitis. Detection of diffusely and irregularly dilated side branches of the pancreatic ducts

Detection of diffusely and irregularly dilated side branches of pancreatic ducts is a reliable criterion for the diagnosis of chronic pancreatitis (Japan Pancreas Society, revised 1995). This review deals with our experience with the utility of Magnetic resonance cholangiopancreatography (MRCP) in detecting this type of ductal abnormalities. Seventy patients with symptoms indicative of pancreatic or biliary diseases were evaluated using both MRCP and endoscopic retrograde chlangiopancreatography (ERCP) within an interval of three months or shorter. Using a 1.5 T unit, a multi-angle oblique multi-slab MRCP using a single-shot fast-spin-echo sequence was used to capture the pancreatic ducts. In 36 patients, MRCP was performed after administration of Gd-DTPA. The MRCP images were blindly and separately evaluated by two radiologists by counting the number of irregularly dilated side-branches in each segment. Two gastroenterologists in consensus evaluated the ERCP images as a standard of reference. The sensitivity, specificity and Az values for MRCP in the diagnosis of chronic pancreatitis were 0.33-0.50, 0.71-0.88 and 0.67-0.79 respectively without Gd-DTPA and 0.50-0.75, 0.78-0.93 and 0.82-0.89 with Gd-DTPA. Multi-angle oblique slab MRCP can be used for diagnosis of chronic pancreatitis with acceptable diagnostic accuracy when it is performed with intravenously administered of Gd chelates. (author)