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Sensitivity of Endoscopic Ultrasound, Multidetector Computed Tomography, and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreas Divisum: A Tertiary Center Experience

Kushnir, Vladimir M. MD*; Wani, Sachin B. MD*; Fowler, Kathryn MD; Menias, Christine MD; Varma, Rakesh MD; Narra, Vamsi MD; Hovis, Christine BS*; Murad, Faris M. MD*; Mullady, Daniel K. MD*; Jonnalagadda, Sreenivasa S. MD*; Early, Dayna S. MD*; Edmundowicz, Steven A. MD*; Azar, Riad R. MD*

doi: 10.1097/MPA.0b013e31826c711a
Original Articles
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Objectives There are limited data comparing imaging modalities in the diagnosis of pancreas divisum. We aimed to: (1) evaluate the sensitivity of endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), and multidetector computed tomography (MDCT) for pancreas divisum; and (2) assess interobserver agreement (IOA) among expert radiologists for detecting pancreas divisum on MDCT and MRCP.

Methods For this retrospective cohort study, we identified 45 consecutive patients with pancreaticobiliary symptoms and pancreas divisum established by endoscopic retrograde pancreatography who underwent EUS and cross-sectional imaging. The control group was composed of patients without pancreas divisum who underwent endoscopic retrograde pancreatography and cross-sectional imaging.

Results The sensitivity of EUS for pancreas divisum was 86.7%, significantly higher than the sensitivity reported in the medical records for MDCT (15.5%) or MRCP (60%) (P < 0.001 for each). On review by expert radiologists, the sensitivity of MDCT increased to 83.3% in cases where the pancreatic duct was visualized, with fair IOA (κ = 0.34). Expert review of MRCPs did not identify any additional cases of pancreas divisum; IOA was moderate (κ = 0.43).

Conclusions Endoscopic ultrasound is a sensitive test for diagnosing pancreas divisum and is superior to MDCT and MRCP. Review of MDCT studies by expert radiologists substantially raises its sensitivity for pancreas divisum.

From the *Division of Gastroenterology and Hepatology, Department of Medicine, and †Department of Radiology, Washington University, St Louis, MO.

Received for publication April 13, 2012; accepted July 23, 2012.

Reprints: Riad Azar, MD, 660 S Euclid Ave, Box 8124, St Louis, MO, 63110 (e-mail: raza3@aol.com).

The authors declare no conflict of interest.

Results of this study were presented in part at Digestive Disease Week 2011, Chicago, IL, in May 9, 2011.

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