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Figure 10a. Severe chronic pancreatitis. (a) MR image obtained 7 minutes after secretin injection shows severe cystic dilatation of side branches in the pancreatic head and irregular dilatation of the main pancreatic duct, with low-signal-intensity filling defects (arrows). The exocrine response to secretin was poor, as demonstrated by the lack of high signal intensity in the duodenum. (b) Corresponding ERCP image helps confirm the presence of main duct filling defects consistent with calculi (arrows), findings indicative of grade 5 chronic pancreatitis. MR cholangiopancreatography has lower sensitivity than does ECRP for depicting pancreatic ductal calculi.
