[Pancreas divisum: Diagnostic importance of MR cholangiopancreatography].

PURPOSE: Pancreas divisum, non-fusion of the ventral and dorsal pancreatic ductal system, affects up to almost 10% of the population. Approximately 20% of the patients with pancreas divilsum will develop complications such as recurrent pancreatitis. In this study, we aimed to present the magnetic resonance cholangiopancreatography (MRCP) findings of pancreas divisum, evaluate its frequency in our study group and illustrate the importance of MRCP in the diagnosis of this anatomic variation.

MATERIALS AND METHODS: Between August 2000 and October 2002, 248 patients suspected of having pancreatobiliary disease underwent MRCP with a 1.0 Tesla scanner. A phased-array coil was used for signal detection. Thirty-five to 70 millimeter thick slabs and thin (3 mm) collimation heavily T2 weighted images were obtained with the SSFSE (single shot fast spin echo) technique. Diagnosis of pancreas divisum was made by evaluation of the thick slabs, source and three dimensional reformatted images.

RESULTS: Eleven of the patients with ages ranging from 23 to 71 years (mean: 55.8 +/- 4.2) were diagnosed as having the variation "pancreas divisum" (4.4%). Ten had symptoms of hepatobiliary disease and one showed signs of recurrent pancreatitis. All but three of the patients were correlated well with ERCP; in one patient ERCP could not be performed due to a cannulation problem secondary to Billroth II procedure and, in two patients ERCP was found to be unnecessary as MRCP was efficient. The patient having signs of pancreatitis was diagnosed as recurrent pancreatitis during the clinical diagnostic work-up. A dominant dorsal duct draining into minor papilla was detected in all patients, only five of them showed a short segment ventral duct in the pancreatic head region, while it was absent in the others.

CONCLUSION: MRCP is a rapid and non-invasive method of evaluating the pancreatic ductal system. It helps in identifying pancreas divisum, which may be the cause of recurrent pancreatitis, and so obviates the need of ERCP.