Secretin-Stimulated Magnetic Resonance Cholangiopancreatography (S-MRCP) as Screening in Familial Pancreatic Cancer (CA) Patients

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 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. 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 MRI/MRA, as well as secretin-enhanced 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 SMRCP, in comparison with EUS and ERCP in identifying
neoplasm in those patients who undergo surgical resection during this study.