Secretin-enhanced Magnetic Resonance Imaging (S-MRI) for Pancreatic Cancer Detection

Pancreatic cancer remains the fourth leading cause of cancer-related death in the United
States and is marked by advanced stage at diagnosis and a high mortality rate. Intraductal
papillary mucinous neoplasm, IPMN, is a cystic lesion that can be potentially cancerous,
leading to pancreatic adenocarcinoma. Currently, there is no existing imaging modality that
is both sensitive and cost-effective enough in accurately measuring or detecting
adenocarcinoma and IPMN. Improving the methods used in identification and localization of
this disease is critical.

Secretin, a hormone produced by duodenal mucosal cells increases blood-flow to the pancreas.
Our hypothesis is that as secretin increases blood flow to the pancreas, there will be
increased conspicuity in areas of dysplasia/cancer where there is minimal blood-flow,
enhancing tumor detection. The investigators are conducting a prospective,
randomized-control pilot study of thirty patients with IPMN or pancreatic cancer who are
undergoing surgical resection at Columbia University's Pancreas Center. Fifteen patients
will be randomly selected to undergo S-MRI prior to surgery and fifteen patients will be
selected as controls, undergoing MRI without secretin-enhancement and matched for age, sex,
race and tumor-type. The investigators will first evaluate if secretin allows for increased
tumor conspicuity, enhanced visualization of the lesion, by comparing the calculated tumor
conspicuity of S-MRI to N-MRI groups.

The investigators will then assess if S-MRI imaging allows for increased accuracy in lesion
measurements by looking at the concordance in measurements between S-MRI and tumor specimens
post-resection as compared to the concordance in measurements between N-MRI and tumor
specimens post-resection.

Inclusion Criteria:

- 18 years of age or older

- Histologically confirmed IPMN/pancreatic adenocarcinoma by biopsy or fine needle or
suspected IPMN/pancreatic adenocarcinoma based on imaging

- Scheduled for surgical resection

- Willingness to provide informed consent.

Exclusion Criteria:

- Any contraindication to MRI, including but not limited to implanted metal devices
(e.g. pacemaker, berry aneurysm clips, neural stimulator or cochlear implants)

- Unresectable tumor

- Other abdominal neoplasm in addition to neoplasm in pancreas

- Contraindication to surgery, including but not limited to recent MI (within 6 weeks)
or poor pulmonary function

- History of sensitivity to secretin

- Pregnancy

- Estimated GFR < 30 mL/min/1.73 m2 (as per MDRD Study equation)

- Unwillingness or inability to provide informed consent.