secretin-enhanced magnetic resonance imaging (s-mri) for pancreatic cancer detection

Conditions: Pancreatic Cancer; Intraductal Papillary Mucinous Neoplasm

Summary: the aim of the study is to evaluate the utility of secretin-enhanced mri (s-mri) in detecting and measuring pancreatic lesions in patients with known adenocarcinoma or intraductal papillary mucinous neoplasm (ipmn) lesions. the hypothesis is that s-mri is superior to mri without secretin enhancement (n-mri) in increasing tumor conspicuity, allowing for improved identification and more accurate measurement of lesions or precursor lesions in the pancreas.

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. the investigators' 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 subjects with ipmn or pancreatic cancer who are undergoing surgical resection at columbia university's pancreas center. fifteen subjects will be randomly selected to undergo s-mri prior to surgery and fifteen subjects 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.

Eligibility criteria:
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 magnetic resonance imaging (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 myocardial infarction (mi) (within 6 weeks) or poor pulmonary function * history of sensitivity to secretin * pregnancy * estimated glomerular filtration rate (gfr) \< 30 ml/min/1.73 m2 (as per modification of diet in renal disease (mdrd) study equation) * unwillingness or inability to provide informed consent.

Keywords: pancreatic adenocarcinoma intraductal papillary mucinous neoplasm imaging techniques pancreatic surgical resection synthetic human secretin