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Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

  • Hepatobiliary-Pancreas
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Abstract

We propose the hypothesis that the enlargement of the common bile duct (CBD) or gallbladder (GB) that is occasionally demonstrated on magnetic resonance cholangiopancreatography (MRCP) after secretin stimulation is caused by pancreatobiliary reflux. Recently, occult pancreatobiliary reflux (OPR) has been demonstrated in patients without morphological pancreatobiliary maljunction (MPBM). The aim of this study was to evaluate the efficacy of secretin-stimulating MRCP (SMRCP) in the diagnosis of pancreatobiliary reflux. The study included 14 patients with MPBM and 32 patients with a normal pancreatobiliary junction. OPR was evaluated by bile collection and diagnosed in seven of the 32 patients. All the patients underwent SMRCP; the related findings were considered positive when enlargement of the CBD or GB was observed. Positive findings on SMRCP were observed in all MPBM patients. In the patients with normal pancreatobiliary junction, there was significant difference between the mean amylase levels in the patients with positive and negative SMRCP findings (mean, 4,755.7 and 29.7 IU/l). The sensitivity and specificity of SMRCP for diagnosing OPR was 85.7% and 68.0%, respectively. SMRCP provides a non invasive method for excluding PBR and can identify patients who could benefit from bile duct sampling to diagnose OPR.

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Acknowledgements

We thank our departmental radiologists, T. Araki, A. Nambu, H. Nakajima, A. Ito, M. Hori, K. Ishigame, H. Sou, M. Nagata, K. Sano, and E. Jin, for collecting the MR data. We gratefully acknowledge the continuing assistance of the doctors from the First Department of Internal Medicine and the First Department of Surgery for their help with regard to bile collection.

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Authors and Affiliations

  1. Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan

    Utaroh Motosugi, Tomoaki Ichikawa & Tsutomu Araki

  2. First Department of Internal Medicine, University of Yamanashi, Chuo-shi, Yamanashi, Japan

    Fumiaki Kitahara & Tadashi Sato

  3. First Department of Surgery, University of Yamanashi, Chuo-shi, Yamanashi, Japan

    Jun Itakura & Hideki Fujii

Authors
  1. Utaroh Motosugi
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  2. Tomoaki Ichikawa
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  3. Tsutomu Araki
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  4. Fumiaki Kitahara
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  5. Tadashi Sato
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  6. Jun Itakura
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  7. Hideki Fujii
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Correspondence to Utaroh Motosugi.

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Motosugi, U., Ichikawa, T., Araki, T. et al. Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux. Eur Radiol 17, 2262–2267 (2007). https://doi.org/10.1007/s00330-007-0640-z

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  • DOI: https://doi.org/10.1007/s00330-007-0640-z

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