Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population

Objectives

To investigate the frequency of pancreatic duct (PD) variants and their effect on pancreatic exocrine function in a population-based study using non-invasive secretin-stimulated magnetic resonance cholangiopancreatography (sMRCP).

Methods

Nine hundred and ninety-five volunteers, 457 women and 538 men, aged 51.9?±?13.4 years, underwent navigator-triggered, T2-weighted, 3D turbo spin echo MRCP on a 1.5 T system after 1 unit/kg secretin administration. Two readers evaluated images for PD variants. Pancreatic exocrine function and morphological signs of chronic pancreatitis such as abnormalities of the main PD, side branch dilatation, and pancreatic cysts were evaluated and related to PD variants using a Kruskal-Wallis test and post hoc analysis.

Results

Of all sMRCP, 93.2 % were of diagnostic quality. Interobserver reliability for detection of PD variants was found to be kappa 0.752 (95 %CI, 0.733 – 0.771). Normal PD variants were observed in 90.4 % (n?=?838/927). Variants of pancreas divisum was identified in 9.6 % (n?=?89/927). Abnormalities of the main PD, side branch dilatation, and pancreatic cysts were observed in 2.4 %, 16.6 %, and 27.7 %, respectively, and were not significantly different between pancreas divisum and non-divisum group (P?=?0.122; P?=?0.152; P?=?0.741). There was no association between PD variants and pancreatic exocrine function (P?=?0.367).

Conclusion

PD variants including pancreas divisum are not associated with morphological signs of chronic pancreatitis or restriction of pancreatic exocrine function.

Key Points

? MRCP allows the evaluation of pancreatic duct variants and morphological change. ? Pancreatic duct variants are not associated with morphological signs of chronic pancreatitis. ? Pancreas divisum is not accompanied by restriction of pancreatic exocrine function. ? Pancreatic duct variants including pancreas divisum are limited in their clinical relevance.