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. 2013 Apr;42(3):436-41.
doi: 10.1097/MPA.0b013e31826c711a.

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

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Free PMC article

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

Vladimir M Kushnir et al. Pancreas. .
Free PMC article

Abstract

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.

Figures

Figure 1
Figure 1
EUS image of complete pancreas divisum, with the dorsal pancreatic duct opening into the minor papilla and the ventral pancreatic duct (dashed arrow) opening into the common bile duct (CBD) seen in the same plane.
Figure 2
Figure 2
MRCP coronal reconstruction showing complete pancreas divisum. The dorsal duct opens anterosuperior to the common bile duct through the minor papilla (solid arrow). The ventral duct draining through the major papilla (dashed arrow).
Figure 3
Figure 3
MDCT showing complete pancreas divisum, with the dorsal pancreatic duct opening into the minor papilla (white arrows) and the dorsal pancreatic duct draining into the major papilla (black arrow).

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