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Prospective Assessment of Normal Pancreatic Secretory Function Measured by MRI in a Cohort of Healthy Children

The American Journal of Gastroenterologyvolume 113pages13851392 (2018) | Download Citation




Magnetic resonance imaging (MRI) with secretin stimulation promises to allow non-invasive testing for exocrine pancreatic insufficiency but normal data do not exist for children. The purpose of this study was to define, in healthy children, normal pancreatic secreted fluid volume and secretion rate, measured by MRI, in response to secretin.


In this Institutional Review Board-approved, prospective, cross-sectional study, 50 healthy children ages 6 to <16 years underwent MRI with secretin stimulation. Images were obtained before and at 1, 5, 10 and 15 min after secretin administration to calculate total secreted fluid volume and secretion rate based on image segmentation. Regression was used to define the relationship between secretory function and participant size measures, and linear quantile regression was used to define normal secretory values based on size measures.


Median total secreted fluid volume post secretin was 79 mL (range: 32–162 mL; 5th and 95th percentiles: 43 and 123 mL) and median secretion rate was 5.1 mL/min (range: 2–9.4 mL/min; 5th and 95th percentiles: 2.3 and 7.7 mL/min). Secreted volume and secretion rate had the strongest correlation with body surface area (BSA) (r = 0.54 and 0.59, respectively) and multiple regression defined BSA as the only significant predictor of secretory function. Each 1 m2 increase in BSA was associated with a 38 mL increase in secreted fluid volume.


In children, pancreatic secretory response to secretin, measured by MRI, depends on participant size, particularly BSA. Secreted volume <43 mL or a secretion rate <2.3 mL/min (5th percentile values) can be considered abnormal for children.

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  1. 1.

    Kolodziejczyk E, Wejnarska K, Dadalski M, et al. The nutritional status and factors contributing to malnutrition in children with chronic pancreatitis. Pancreatology. 2014;14:275–9.

  2. 2.

    Rana M, Wong-See D, Katz T, et al. Fat-soluble vitamin deficiency in children and adolescents with cystic fibrosis. J Clin Pathol. 2014;67:605–8.

  3. 3.

    Somaraju UR, Solis-Moya A. Pancreatic enzyme replacement therapy for people with cystic fibrosis. Cochrane Database Syst Rev. 2014;10:CD008227.

  4. 4.

    Arya VB, Senniappan S, Demirbilek H, et al. Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism. PLoS ONE. 2014;9:e98054.

  5. 5.

    Trang T, Chan J, Graham DY. Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency in the 21(st) century. World J Gastroenterol. 2014;20:11467–85.

  6. 6.

    Waye JD, Adler M, Dreiling DA. The pancreas: a correlation of function and structure. Am J Gastroenterol. 1978;69:176–81.

  7. 7.

    Conwell DL, Zuccaro G Jr., Vargo JJ, et al. An endoscopic pancreatic function test with synthetic porcine secretin for the evaluation of chronic abdominal pain and suspected chronic pancreatitis. Gastrointest Endosc. 2003;57:37–40.

  8. 8.

    Conwell DL, Zuccaro G Jr., Vargo JJ, et al. An endoscopic pancreatic function test with cholecystokinin-octapeptide for the diagnosis of chronic pancreatitis. Clin Gastroenterol Hepatol. 2003;1:189–94.

  9. 9.

    Alfaro Cruz L, Parniczky A, Mayhew A, et al. Utility of direct pancreatic function testing in children. Pancreas. 2017;46:177–82.

  10. 10.

    Dreiling DA. Pancreatic secretory testing in 1974. Gut. 1975;16:653–7.

  11. 11.

    Mensel B, Messner P, Mayerle J, et al. Secretin-stimulated MRCP in volunteers: assessment of safety, duct visualization, and pancreatic exocrine function. AJR Am J Roentgenol. 2014;202:102–8.

  12. 12.

    Wathle GK, Tjora E, Ersland L, et al. Assessment of exocrine pancreatic function by secretin-stimulated magnetic resonance cholangiopancreaticography and diffusion-weighted imaging in healthy controls. J Magn Reson Imaging. 2014;39:448–54.

  13. 13.

    Bian Y, Wang L, Chen C, et al. Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP. World J Gastroenterol. 2013;19:7177–82.

  14. 14.

    Sanyal R, Stevens T, Novak E, et al. Secretin-enhanced MRCP: review of technique and application with proposal for quantification of exocrine function. AJR Am J Roentgenol. 2012;198:124–32.

  15. 15.

    Manfredi R, Perandini S, Mantovani W, et al. Quantitative MRCP assessment of pancreatic exocrine reserve and its correlation with faecal elastase-1 in patients with chronic pancreatitis. Radiol Med. 2012;117:282–92.

  16. 16.

    Schneider AR, Hammerstingl R, Heller M, et al. Does secretin-stimulated MRCP predict exocrine pancreatic insufficiency?: A comparison with noninvasive exocrine pancreatic function tests. J Clin Gastroenterol. 2006;40:851–5.

  17. 17.

    Gillams A, Pereira S, Webster G, et al. Correlation of MRCP quantification (MRCPQ) with conventional non-invasive pancreatic exocrine function tests. Abdom Imaging. 2008;33:469–73.

  18. 18.

    Matos C, Metens T, Deviere J, et al. Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology. 1997;203:435–41.

  19. 19.

    Cappeliez O, Delhaye M, Deviere J, et al. Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology. 2000;215:358–64.

  20. 20.

    Trout AT, Wallihan DB, Serai S, et al. Secretin-enhanced magnetic resonance cholangiopancreatography for assessing pancreatic secretory function in children. J Pediatr. 2017;188:186–91.

  21. 21.

    Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr. 1978;93:62–6.

  22. 22.

    Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.

  23. 23.

    Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol. 2012;8:23–34.

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Daniel B. Wallihan, MD for his contributions in developing the quantitative MRI technique.

Author information


  1. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    • Andrew T. Trout MD
  2. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    • Andrew T. Trout MD
    • , Suraj D. Serai PhD
    •  & Qin Sun MPH
  3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    • Lin Fei PhD
  4. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    • Maisam Abu-El-Haija MD


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Guarantor of the article

Andrew T. Trout, MD.

Specific author contributions

ATT—study planning, study conduct, collecting data, interpreting data, and drafting manuscript. SDS—study planning, study conduct, and drafting manuscript. LF—study planning, interpreting data, and drafting manuscript. QS—interpreting data and drafting manuscript. MA-E-H—study planning, study conduct, collecting data, interpreting data, and drafting manuscript. Each author has approved the final draft of the manuscript as submitted

Financial support

This work was funded by a grant from the National Pancreas Foundation.

Potential competing interests

ATT has investigator initiated grants for unrelated studies from Toshiba America Medical Systems and Siemens Medical Solutions. ATT has received travel support from Philips Healthcare to attend an MRI users group meeting. ChiRhoClin Inc. provided secretin for this study. The remaining authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Andrew T. Trout MD.

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