Secretin-Stimulated Magnetic Resonance Cholangiopancreatography (S-MRCP) in Pancreatic Patients
Secretin-Stimulated Magnetic Resonance Cholangiopancreatography (S-MRCP) in Pancreatic Patients
The aim of our study is to evaluate the utility of Secretin-Stimulated Magnetic Resonance
 Cholangiopancreatography (S-MRCP) in detecting carcinoma and precancerous lesions in patients
 with a significant family history of pancreatic adenocarcinoma. Our hypothesis is that S-MRCP
 is superior to traditional computed tomography (CT) or magnetic resonance imaging (MRI) in
 detecting early pancreatic neoplasms, and approaches the accuracy of endoscopic ultrasound
 (EUS).
Pancreatic cancer remains the fourth leading cause of cancer-related death in the United
 States, largely due to the lack of accurate and cost-effective screening methods. Initial
 screening efforts should be directed at patients with known increased genetic risk for
 pancreatic adenocarcinoma. About 10-20% of pancreatic cancers are considered familial or
 syndromic. Since pancreatic adenocarcinoma is known to progress from preneoplastic lesions,
 termed pancreatic intraepithelial neoplasia (PanIN), it may eventually be possible to
 identify and cure patients by detecting preneoplastic lesions. Traditional radiological
 methods lack the resolution to detect early lesions. The sensitivity and specificity of
 endoscopic retrograde cholangiopancreatography (ERCP) (92%,96%) and EUS (93-98%)are better,
 but these procedures are invasive and limited in availability. Magnetic resonance
 cholangiopancreatography (MRCP) has emerged as a widely-accepted alternative with comparable
 sensitivity to ERCP. Magnetic Resonance Cholangiopancreatography (MRCP) has been further
 augmented by secretin stimulation, which improves visualization of the pancreatic duct as
 well as side branches. We will recruit 25 patients for a prospective pilot study examining
 S-MRCP as a screening technique in high-risk individuals. All recruited patients will undergo
 S-MRCP in conjunction with magnetic resonance imaging (MRI)/magnetic resonance angiography
 (MRA), as well as secretin-enhanced EUS (S-EUS). Those patients with abnormalities on S-MRCP
 or S-EUS will undergo ERCP. If ERCP also shows abnormalities, these patients will be
 recommended total or subtotal pancreatectomy. The primary outcome that we will be studying
 will be concordance of S-MRCP and EUS. Secondarily, we will be measuring positive predictive
 value of S-MRCP, in comparison with EUS and ERCP in identifying neoplasm in those patients
 who undergo surgical resection during this study.
Inclusion Criteria:

 -  18 years of age and older.

 -  At least two first or two second degree relatives with pancreatic adenocarcinoma (the
 study subject will be either 10 years younger than the youngest age at which a
 relative was diagnosed with pancreatic cancer, or the study subject will be at least
 25 years of age).

 -  Fulfills criteria or has undergone genetic testing which confirms BRCA1 (BReast CAncer
 gene 1), BRCA2 (BReast CAncer gene 2), Familial Atypical Multiple Mole Melanoma,
 PeutzJeghers, Hereditary nonpolyposis colorectal cancer (HNPCC), Hereditary
 Pancreatitis, or ataxiatelangiectasia.

 Exclusion Criteria:

 -  Any contraindication to MRI, including but not limited to implanted metal devices
 (e.g. pacemaker,berry aneurysm clips, neural stimulator or cochlear implants).

 -  Known pancreatic malignancy or dysplasia.

 -  Pregnancy.

 -  History of sensitivity to secretin.

 -  Creatinine greater than 2.

 -  Unwillingness or inability to provide informed consent.