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MRI assessed pancreatic morphology and exocrine function are associated with disease burden in chronic pancreatitis

Madzak, Adnana; Olesen, Søren Schoub,c; Lykke Poulsen, Jakobb; Bolvig Mark, Esbena,b; Mohr Drewes, Asbjørnb,c; Frøkjær, Jens Brønduma,c

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1269–1275
doi: 10.1097/MEG.0000000000000955
Original Articles: Pancreatic Disease

Background and aim The aim of this study was to explore the association between morphological and functional secretin-stimulated MRI parameters with hospitalization, quality of life (QOL), and pain in patients with chronic pancreatitis (CP).

Patients and methods This prospective cohort study included 82 patients with CP. Data were obtained from clinical information, QOL, and pain as assessed by questionnaires (The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and modified Brief Pain Inventory short form). Secretin-stimulated MRI morphological parameters included pancreatic gland volume, main pancreatic duct diameter, the modified Cambridge Classification of Duct Abnormality, apparent diffusion coefficient, fat signal fraction, and the pancreatic secretion volume as a functional parameter. The primary outcomes were time to first hospitalization related to the CP, as well as annual hospitalization frequency and duration. The secondary outcomes were pain severity, QOL, and pain interference scores.

Results A main pancreatic duct diameter below 5 mm was associated with reduced time to first hospitalization (hazard ratio=2.06; 95% confidence interval: 1.02–4.17; P=0.043). Pancreatic secretion volume was correlated with QOL (r=0.31; P=0.0072) and pain interference score (r=−0.27; P=0.032), and fecal elastase was also correlated with QOL (r=0.28; P=0.017). However, functional and morphological findings were not related to pain intensity.

Conclusion Advanced pancreatic imaging techniques may be a highly sensitive tool for prognostication and monitoring of disease activity and its consequences.

Supplemental Digital Content is available in the text.

aDepartment of Radiology, Imaging Research Unit & Mech-Sense

bDepartment of Gastroenterology & Hepatology, Centre for Pancreatic Diseases & Mech-Sense, Aalborg University Hospital

cDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark

Correspondence to Jens Brøndum Frøkjær, MD, PhD, Department of Radiology, Aalborg University Hospital, PO Box 365, DK-9100 Aalborg, Denmark Tel: +45 9766 5105; fax: +45 9766 5257; e-mail: jebf@rn.dk

Received May 9, 2017

Accepted July 8, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.