Performance Characteristics of Magnetic Resonance Imaging in Patients with Pancreas Divisum

Rushikesh Shah, Parit Mekaroonkamol, Vaishali A. Patel, Kara Raphael, Sunil Dacha, Steven A. Keilin, Qiang Cai, Pardeep Mittal, Field F. Willingham

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective This study was designed to assess the diagnostic accuracy of standard nonsecretin-enhanced preprocedural magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) in patients with and without pancreas divisum. Methods Patients undergoing MRI/MRCP followed by endoscopic retrograde cholangiopancreatography with between 2009 and 2016 were reviewed. The diagnostic accuracy of the MRI/MRCP was evaluated against the pancreatography. A subsequent independent blinded re-review performed by an expert abdominal radiologist was also evaluated. Multivariate binary logistic regression was performed to assess the impact of clinicopathologic factors on the diagnostic accuracy. Results A total of 189 patients were included in analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI/MRCP for pancreas divisum were 63%, 97%, 94%, and 82% initially and 81%, 91%, 91%, and 82% on the expert review. Motion artifact, the presence of pancreatic tumor, and pancreatic necrosis were not found to significantly impact the accuracy. A normal diameter pancreatic duct (P = 0.04) and complete divisum anatomy were correlated with improved accuracy (P = 0.001). Conclusions Although expert review, normal duct diameter, and complete divisum are associated with increased sensitivity, pancreas divisum may be uncharacterized by preprocedural MRI in 19% to 37% of patients before the index endoscopic retrograde cholangiopancreatography.

Original languageEnglish (US)
Pages (from-to)1343-1347
Number of pages5
Issue number10
StatePublished - Nov 1 2019
Externally publishedYes


  • ERCP
  • MRCP
  • pancreas divisum
  • pancreatitis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology


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