Accuracy of magnetic resonance cholangiopancreatography in identifying pancreatic duct disruption.

GOALS: Endoscopic retrograde pancreatography is the gold standard diagnostic study for pancreatic duct (PD) pathology but carries significant risks. Our aim was to assess the ability of magnetic resonance cholangiopancreatography (MRCP) to delineate PD disruption.
BACKGROUND: PD disruption is a significant clinical event and portends a more severe clinical course after acute pancreatitis or other pancreatic injury. Knowledge of such a disruption can direct a more aggressive medical therapy early in the disease course and might also select those patients likely to benefit from early endoscopic intervention. MRCP has been evaluated abundantly in the context of biliary disease. Conversely, the role of MRCP in the investigation of PD pathology has been little studied. STUDY: A retrospective analysis identified consecutive patients between 2000 and 2008 undergoing endoscopic retrograde cholangiopancreatography (ERCP) for the indication of pancreatitis. Records were then reviewed to subselect only those patients with proximate ERCP and MRCP. The radiologist reviewing the MRCP was blinded to all clinical and imaging data except a brief clinical synopsis provided by the other authors.
RESULTS: Thirty-one patients had MRCP within 7 days of the ERCP. MRCP preceded ERCP in 84% (26/31) patients, with ERCP performed a median 2.2 (range, 0 to 7) days after MRCP. PD disruption was found at ERCP in 74% (23/31) of patients; MRCP confirmed 91% (21/23) of the duct disruptions. In the 8 patients with intact PD at ERCP, MRCP correctly reported an intact PD.
CONCLUSIONS: MRCP performed for a suspected PD fistula is highly accurate in assessing the integrity of the PD.