Dynamic Secretin-enhanced MRCP Protocol

Information for Scheduling the Exam

1. NPO 4 - 6 hours prior to the exam
2. Arrive 1 hour prior to exam time
3. 45 minute time slot
4. Ask the patient if there are any prior outside CT scans or MRI exams that relate to the current exam so the radiologist can compare when interpreting the current study. On the day of the exam, the patient can bring this with them on a CD.

Information for MRI Technologists

Background

1. Secretin
1. Secretin is administered intravenously over 1 minute to avoid abdominal pain that may occur with a bolus injection.
2. Dose- 0.2ug/kg.
3. Maximum effect is 5 – 7 minutes.
4. Side effects are infrequent and include…

i. Abdominal cramps, abdominal discomfort, nausea, vomiting, bloating, bradycardia, decreased blood pressure, diaphoresis, and diarrhea.

Pulse Sequences

1. Survey
2. Coronal SS-TSE (TE~200) (7 mm slice thickness at 5 mm increments with 2 mm overlap)
3. Axial SS-TSE (TE~200) (7 mm slice thickness at 5 mm increments with 2 mm overlap)
4. Axial In/Out Phase
5. MRCP Slab
1. 40 mm thickness
2. Choose the best image that visualizes the pancreatic duct without overlap of the CBD
3. Administer Secretin: 0.2ug/kg administered intravenously over 1 minute
4. Repeat the selected MRCP image every 30 seconds for 10 minutes
6. MRCP 3D HR
7. Axial E-THRIVE Pre
8. Axial PROSET (This series is performed only if post contrast series 9 & 10 are not obtained)
9. Axial E-THRIVE Dynamic Post**
10. Axial E-THRIVE Venous Post**
11. Axial SPAIR (TE~80) (7 mm slice thickness at 5 mm increments with 2 mm overlap)
12. Axial DWI 0 – 20 – 800à Please send ADC Map to iSite

**NOTE: Post contrast series 9 & 10 should be performed unless a contrast enhanced MRI has been performed within the last 2 months.

Documentation for the “MEMO” section on iSite

1. In the memo section on iSite, please list the following…
1. Dose of Secretin administered.
2. PO Contrast dose if given.

References

• Assessment of Chronic Pancreatitis: Utility of Diffusion-weighted MR Imaging with Secretin Enhancement Radiology January 2009

• Dynamic Secretin-enhanced MR Cholangiopancreatography Radiographics May 2006
• MR Imaging of the Pancreas: A Pictorial Tour Radiographics January 2002
• Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation Radiology May 1997

• Secretin-Enhanced MRCP: Review of Technique and Application With Proposal for Quantification of Exocrine Function AJR January 2012

Rev: April 14, 2015