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Idiopathic Chronic Pancreatitis in Children: MR Cholangiopancreatography after Secretin Administration¹

¹ From the Departments of Radiology (R.M., B.G., M.G.B., A.V., G.M., P.M.) and Endoscopic Surgery (G.C.), A. Gemelli University Hospital, 8 Largo A. Gemelli, Rome 00168, Italy; and Departments of Gastroenterology (V.L.) and Endoscopic Surgery (L.D.), Bambino Gesù Children’s Hospital, Rome, Italy. From the 2000 RSNA scientific assembly. Received June 20, 2001; revision requested August 15; revision received November 5; accepted March 25, 2002. Address correspondence to R.M. (e-mail: rmanfredi@rm.unicatt.it).

View larger version (100K): [in a new window]   Figure 1a. (a, b) Coronal T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct does not appear dilated; only the segments in the head (arrow) and body (arrowhead) of the gland are faintly depicted. (b) On an image obtained after secretin administration, all segments of the main pancreatic duct are visualized; the dilated side branches in the head and body of the pancreas (arrows) indicate early chronic pancreatitis. Furthermore, the contour of the main pancreatic duct is irregular in the tail. (c, d) ERCP images (d is a close-up of part of c) confirms the dilatation of some side branches (arrows in c) and the irregular contour of the main pancreatic duct (arrows in d).

View larger version (115K): [in a new window]   Figure 1b. (a, b) Coronal T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct does not appear dilated; only the segments in the head (arrow) and body (arrowhead) of the gland are faintly depicted. (b) On an image obtained after secretin administration, all segments of the main pancreatic duct are visualized; the dilated side branches in the head and body of the pancreas (arrows) indicate early chronic pancreatitis. Furthermore, the contour of the main pancreatic duct is irregular in the tail. (c, d) ERCP images (d is a close-up of part of c) confirms the dilatation of some side branches (arrows in c) and the irregular contour of the main pancreatic duct (arrows in d).

View larger version (95K): [in a new window]   Figure 1c. (a, b) Coronal T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct does not appear dilated; only the segments in the head (arrow) and body (arrowhead) of the gland are faintly depicted. (b) On an image obtained after secretin administration, all segments of the main pancreatic duct are visualized; the dilated side branches in the head and body of the pancreas (arrows) indicate early chronic pancreatitis. Furthermore, the contour of the main pancreatic duct is irregular in the tail. (c, d) ERCP images (d is a close-up of part of c) confirms the dilatation of some side branches (arrows in c) and the irregular contour of the main pancreatic duct (arrows in d).

View larger version (80K): [in a new window]   Figure 1d. (a, b) Coronal T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct does not appear dilated; only the segments in the head (arrow) and body (arrowhead) of the gland are faintly depicted. (b) On an image obtained after secretin administration, all segments of the main pancreatic duct are visualized; the dilated side branches in the head and body of the pancreas (arrows) indicate early chronic pancreatitis. Furthermore, the contour of the main pancreatic duct is irregular in the tail. (c, d) ERCP images (d is a close-up of part of c) confirms the dilatation of some side branches (arrows in c) and the irregular contour of the main pancreatic duct (arrows in d).

View larger version (130K): [in a new window]   Figure 2a. (a, b) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/1,305) in a patient with severe chronic pancreatitis. (a) Image obtained before secretin administration shows a markedly dilated and tortuous main pancreatic duct (arrowheads) with dilated side branches (straight arrows). Narrowing of the main pancreatic duct is observed in the body of the gland (curved arrow). (b) The narrowing of the main pancreatic duct (arrow) is better demonstrated on an image obtained after secretin administration because of upstream dilatation of the main pancreatic duct. Duodenal filling is also reduced (ie, it is limited to the duodenal bulb [*]). (c) ERCP image confirms the dilatation of the main pancreatic duct and the side branches (arrows), as well as the ductal narrowing (arrowhead).

View larger version (127K): [in a new window]   Figure 2b. (a, b) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/1,305) in a patient with severe chronic pancreatitis. (a) Image obtained before secretin administration shows a markedly dilated and tortuous main pancreatic duct (arrowheads) with dilated side branches (straight arrows). Narrowing of the main pancreatic duct is observed in the body of the gland (curved arrow). (b) The narrowing of the main pancreatic duct (arrow) is better demonstrated on an image obtained after secretin administration because of upstream dilatation of the main pancreatic duct. Duodenal filling is also reduced (ie, it is limited to the duodenal bulb [*]). (c) ERCP image confirms the dilatation of the main pancreatic duct and the side branches (arrows), as well as the ductal narrowing (arrowhead).

View larger version (140K): [in a new window]   Figure 2c. (a, b) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/1,305) in a patient with severe chronic pancreatitis. (a) Image obtained before secretin administration shows a markedly dilated and tortuous main pancreatic duct (arrowheads) with dilated side branches (straight arrows). Narrowing of the main pancreatic duct is observed in the body of the gland (curved arrow). (b) The narrowing of the main pancreatic duct (arrow) is better demonstrated on an image obtained after secretin administration because of upstream dilatation of the main pancreatic duct. Duodenal filling is also reduced (ie, it is limited to the duodenal bulb [*]). (c) ERCP image confirms the dilatation of the main pancreatic duct and the side branches (arrows), as well as the ductal narrowing (arrowhead).

View larger version (114K): [in a new window]   Figure 3a. Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with severe chronic pancreatitis. (a) Image obtained before secretin administration shows a dilated main pancreatic duct with dilated side branches (arrows); one short segment of the main pancreatic duct in the head is not visualized (arrowhead). (b) Image obtained after secretin administration shows increased endoluminal fluid content with passage of fluid along the lateral wall of the main pancreatic duct (arrow); this image better depicts a filling defect (arrowhead) in the main pancreatic duct in the head of the pancreas. This filling defect was confirmed with a conventional radiograph (not shown) to be due to calculi.

View larger version (112K): [in a new window]   Figure 3b. Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/886) in a patient with severe chronic pancreatitis. (a) Image obtained before secretin administration shows a dilated main pancreatic duct with dilated side branches (arrows); one short segment of the main pancreatic duct in the head is not visualized (arrowhead). (b) Image obtained after secretin administration shows increased endoluminal fluid content with passage of fluid along the lateral wall of the main pancreatic duct (arrow); this image better depicts a filling defect (arrowhead) in the main pancreatic duct in the head of the pancreas. This filling defect was confirmed with a conventional radiograph (not shown) to be due to calculi.

View larger version (105K): [in a new window]   Figure 4a. (a-c) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/812) show acinar filling (parenchymography) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct is seen with difficulty in only the body of the pancreas. (b) On an image obtained 3 minutes after secretin administration, all segments of the main pancreatic duct (arrows) are depicted. (c) Furthermore, on an image obtained 10 minutes after secretin administration, acinar filling (arrows) is depicted. Duodenal filling is beyond the genu inferius (*), indicating preservation of the pancreatic functional reserve.

View larger version (111K): [in a new window]   Figure 4b. (a-c) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/812) show acinar filling (parenchymography) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct is seen with difficulty in only the body of the pancreas. (b) On an image obtained 3 minutes after secretin administration, all segments of the main pancreatic duct (arrows) are depicted. (c) Furthermore, on an image obtained 10 minutes after secretin administration, acinar filling (arrows) is depicted. Duodenal filling is beyond the genu inferius (*), indicating preservation of the pancreatic functional reserve.

View larger version (132K): [in a new window]   Figure 4c. (a-c) Coronal heavily T2-weighted single-shot RARE MR cholangiopancreatograms (/812) show acinar filling (parenchymography) in a patient with mild chronic pancreatitis. (a) On an image obtained before secretin administration, the main pancreatic duct is seen with difficulty in only the body of the pancreas. (b) On an image obtained 3 minutes after secretin administration, all segments of the main pancreatic duct (arrows) are depicted. (c) Furthermore, on an image obtained 10 minutes after secretin administration, acinar filling (arrows) is depicted. Duodenal filling is beyond the genu inferius (*), indicating preservation of the pancreatic functional reserve.

View larger version (25K): [in a new window]   Figure 5. Graph depicts the mean diameter of the main pancreatic duct in the head (), body (), and tail () of the pancreas at 0, 1, 3, 5, and 10 minutes after secretin administration.