Medline ® Abstract for Reference 40
of 'Pancreas divisum: Clinical manifestations and diagnosis'
Sensitivity of endoscopic ultrasound, multidetector computed tomography, and magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum: a tertiary center experience.
Kushnir VM, Wani SB, Fowler K, Menias C, Varma R, Narra V, Hovis C, Murad FM, Mullady DK, Jonnalagadda SS, Early DS, Edmundowicz SA, Azar RR
Pancreas. 2013 Apr;42(3):436-41.
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 recordsfor 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.
Division of Gastroenterology and Hepatology, Department of Medicine, Washington University, St Louis, MO 63110, USA.