Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 20 peer-reviewed journal articles Updated
Radiology

Diagnostic Imaging and Function Testing

At a Glance

Diagnosing chronic pancreatitis often requires both imaging and pancreatic function testing. CT, MRCP, or EUS can reveal structural damage, while fecal elastase assesses digestive enzyme production; a watery stool sample may falsely lower the result, and a normal CT does not exclude early disease.

Diagnosing Chronic Pancreatitis (CP) is often a stepwise process. Because early damage to the pancreas can be subtle, doctors use a combination of your clinical history, advanced imaging to look at the organ’s structure, and functional tests to see how well it is working [1][2].

The Imaging Pathway: Mapping the Damage

Your care team typically begins with non-invasive scans to look for irreversible morphological changes—physical signs that the pancreas has been damaged over time [1]. The choice and order of these tests depend on your symptoms, prior imaging, local expertise, and considerations regarding radiation and contrast dyes [1].

  • Computed Tomography (CT) Scan: Often used early on, CT is excellent for detecting calcifications (calcium stones) and identifying complications like pseudocysts (fluid collections) [3][4]. However, a normal CT cannot rule out early-stage disease [5].
  • Magnetic Resonance Cholangiopancreatography (MRCP): This specialized MRI uses no radiation and provides much better detail of the pancreatic ducts and can detect subtle irregularities or “side-branch” dilations that a CT might miss [6][7].
  • Endoscopic Ultrasound (EUS): If cross-sectional imaging (CT/MRI) remains inconclusive, an EUS may be performed [1]. A thin, flexible tube with an ultrasound probe is passed down your throat under sedation to get high-resolution images from just inches away from the pancreas [8]. It is highly sensitive for detecting indirect markers of early scarring, though interpretation relies heavily on the doctor’s expertise and it does not directly measure fibrosis [9][10].

Because no single scan reliably establishes early chronic pancreatitis, equivocal (unclear) results often require specialist review and ongoing follow-up [5]. During these scans, radiologists search for specific “hallmarks” of CP, including calcifications, atrophy (shrinking of the gland), and ductal changes (widening or strictures) [11][12].

Testing Pancreatic Function

While imaging looks at how the pancreas looks, function tests measure how it works—specifically its ability to produce digestive enzymes. This is critical for diagnosing Exocrine Pancreatic Insufficiency (EPI) [2].

Fecal Elastase-1 (FE-1)

The Fecal Elastase-1 test is the most common way to screen for EPI because it only requires a single stool sample [13].

  • The “Solid Stool” Rule: It is vital that the sample provided is semi-solid or solid [13]. If you provide a watery or diarrheal sample, the water dilutes the concentration of the enzyme. This can lead to a false positive or falsely low concentration, suggesting you have EPI when you actually do not [14].
  • Understanding the Numbers:
    • >200 µg/g: Generally considered normal, though it does not completely rule out mild EPI [13].
    • 100–200 µg/g: An indeterminate or “gray area” result that may require repeat testing or evaluation alongside other nutritional labs [13][15].
    • <100 µg/g: Strong evidence of Exocrine Pancreatic Insufficiency [13][15].

Note: You do not need to stop taking prescribed pancreatic enzyme replacement therapy (PERT) for this test, as the laboratory test does not react to the human elastase in your medication [13][16].

Specialized Diagnostic Tools

In complex or early-stage cases in specialized centers, your doctor may use “stimulated” reference tests to get a clearer picture.

  • Secretin-Enhanced MRCP (S-MRCP): You are given an injection of secretin, a hormone that tells your pancreas to produce digestive fluid [5]. This fluid “plumps up” the pancreatic ducts on the MRI, making it much easier to see subtle blockages or abnormalities [17][18]. It also allows doctors to measure how much fluid your pancreas is actually producing [5].
  • Direct Secretin Stimulation Test (ePFT): This is a more invasive specialized reference test [19]. During an endoscopy, secretin is given, and a small tube is used to collect the actual digestive juices produced by your pancreas over about 30–60 minutes [20]. The lab then measures the bicarbonate concentration; a low level is a sign of early pancreatic damage, though availability and specific laboratory cutoffs (such as 80 mEq/L) vary by protocol and center [20][19].

Common questions in this guide

Can a normal CT scan rule out early chronic pancreatitis?
No. CT is useful for finding calcifications and complications such as pseudocysts, but a normal CT can miss early chronic pancreatitis. If symptoms or other findings remain concerning, MRCP, EUS, specialist review, or follow-up may be considered.
What do the numbers on a fecal elastase test mean?
A result above 200 micrograms per gram is generally considered normal, although it may not exclude mild exocrine pancreatic insufficiency. A result of 100 to 200 is an indeterminate range, while a result below 100 strongly supports exocrine pancreatic insufficiency. Clinicians interpret the number with symptoms and other tests.
Can watery stool make my fecal elastase result inaccurate?
Yes. Water in a loose or diarrheal sample can dilute the enzyme and cause a falsely low result that suggests exocrine pancreatic insufficiency. A semi-solid or solid sample is preferred, and your clinician may recommend repeating an unclear result.
Do I need to stop pancreatic enzymes before a fecal elastase test?
Usually no. Fecal elastase testing measures human elastase and does not react to the elastase in prescribed pancreatic enzyme replacement therapy. Follow your clinician's instructions before changing any medication.
Which imaging test is best for diagnosing chronic pancreatitis?
There is no single best scan for every person, and doctors consider symptoms, prior imaging, radiation, contrast, and local expertise. CT can show calcifications and pseudocysts, MRCP shows the pancreatic ducts in detail without radiation, and EUS can provide high-resolution images when CT or MRI is inconclusive.
What are secretin-based tests used for in chronic pancreatitis?
Secretin-enhanced MRCP can make the pancreatic ducts easier to see and can help estimate fluid production. A direct secretin stimulation test collects pancreatic fluid during an endoscopy and measures bicarbonate, which may reveal early damage. These specialized tests are usually considered when routine imaging or function testing is inconclusive.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Which imaging tests have I already had, and do they show specific signs of damage like calcifications, atrophy, or duct changes?
  2. 2.Based on my symptoms and prior scans, what is the best next imaging step for me?
  3. 3.What was my exact Fecal Elastase-1 value, and should we repeat the test if my stool sample was not fully solid?
  4. 4.Do you recommend a specialized direct secretin stimulation test to get a more precise measurement of my pancreatic function?
  5. 5.How do my imaging results and function tests together help determine if I have definite, probable, or early-stage chronic pancreatitis?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (20)
  1. 1

    Diagnosing Chronic Pancreatitis.

    Anaizi A, Hart PA, Conwell DL

    Digestive diseases and sciences 2017; (62(7)):1713-1720 doi:10.1007/s10620-017-4493-2.

    PMID: 28315036
  2. 2

    Chronic pancreatitis.

    Beyer G, Habtezion A, Werner J, et al.

    Lancet (London, England) 2020; (396(10249)):499-512 doi:10.1016/S0140-6736(20)31318-0.

    PMID: 32798493
  3. 3

    Advanced imaging techniques for chronic pancreatitis.

    Parakh A, Tirkes T

    Abdominal radiology (New York) 2020; (45(5)):1420-1438 doi:10.1007/s00261-019-02191-0.

    PMID: 31428813
  4. 4

    Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report.

    Lin TK, Troendle DM, Wallihan DB, et al.

    Journal of pediatric gastroenterology and nutrition 2017; (64(3)):472-484 doi:10.1097/MPG.0000000000001371.

    PMID: 28230608
  5. 5

    Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis.

    Frøkjær JB, Akisik F, Farooq A, et al.

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2018; (18(7)):764-773 doi:10.1016/j.pan.2018.08.012.

    PMID: 30177434
  6. 6

    Magnetic resonance cholangiopancreatography findings in early chronic pancreatitis diagnosed according to the Japanese Diagnostic Criteria.

    Ito T, Ikeura T, Tanaka T, et al.

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2020; (20(4)):596-601 doi:10.1016/j.pan.2020.04.008.

    PMID: 32371200
  7. 7

    Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis.

    Issa Y, Kempeneers MA, van Santvoort HC, et al.

    European radiology 2017; (27(9)):3820-3844 doi:10.1007/s00330-016-4720-9.

    PMID: 28130609
  8. 8

    Imaging of Fibrosis in Chronic Pancreatitis.

    Yamashita Y, Ashida R, Kitano M

    Frontiers in physiology 2021; (12()):800516 doi:10.3389/fphys.2021.800516.

    PMID: 35082692
  9. 9

    Defining the endoscopic ultrasound features of chronic pancreatitis in Asians: a multicenter validation study.

    Koh CJ, Lakhtakia S, Kida M, et al.

    Endoscopy 2021; (53(6)):595-602 doi:10.1055/a-1217-3112.

    PMID: 32650341
  10. 10

    A Comparative Study of Endoscopic Ultrasonography and Histopathology Images for the Diagnosis of Early Chronic Pancreatitis.

    Sekine M, Tanaka A, Akimoto M, et al.

    Pancreas 2021; (50(8)):1173-1179 doi:10.1097/MPA.0000000000001893.

    PMID: 34714281
  11. 11

    Chronic pancreatitis: An international draft consensus proposal for a new mechanistic definition.

    Whitcomb DC, Frulloni L, Garg P, et al.

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2016; (16(2)):218-24.

    PMID: 26924663
  12. 12

    Computed tomography based scoring system in a prospectively ascertained cohort of patients with chronic pancreatitis.

    Dasyam AK, Vipperla K, Slivka A, et al.

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2019; (19(8)):1027-1033 doi:10.1016/j.pan.2019.09.013.

    PMID: 31630919
  13. 13

    AGA Clinical Practice Update on the Epidemiology, Evaluation, and Management of Exocrine Pancreatic Insufficiency: Expert Review.

    Whitcomb DC, Buchner AM, Forsmark CE

    Gastroenterology 2023; (165(5)):1292-1301 doi:10.1053/j.gastro.2023.07.007.

    PMID: 37737818
  14. 14

    The clinical and laboratory impact of reporting faecal elastase-1 in watery stool samples.

    Jones AM

    Annals of clinical biochemistry 2023; (60(1)):72-74 doi:10.1177/00045632221143678.

    PMID: 36424839
  15. 15

    Diagnostic Performance of Measurement of Fecal Elastase-1 in Detection of Exocrine Pancreatic Insufficiency: Systematic Review and Meta-analysis.

    Vanga RR, Tansel A, Sidiq S, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2018; (16(8)):1220-1228.e4 doi:10.1016/j.cgh.2018.01.027.

    PMID: 29374614
  16. 16

    Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test.

    Domínguez-Muñoz JE, D Hardt P, Lerch MM, Löhr MJ

    Digestive diseases and sciences 2017; (62(5)):1119-1130 doi:10.1007/s10620-017-4524-z.

    PMID: 28315028
  17. 17

    Secretin-Enhanced MRCP: How and Why-AJR Expert Panel Narrative Review.

    Swensson J, Zaheer A, Conwell D, et al.

    AJR. American journal of roentgenology 2021; (216(5)):1139-1149 doi:10.2214/AJR.20.24857.

    PMID: 33263419
  18. 18

    The clinical value of secretin-enhanced MRCP in the functional and morphological assessment of pancreatic diseases.

    Chamokova B, Bastati N, Poetter-Lang S, et al.

    The British journal of radiology 2018; (91(1084)):20170677 doi:10.1259/bjr.20170677.

    PMID: 29206061
  19. 19

    EUS and secretin endoscopic pancreatic function test predict evolution to overt structural changes of chronic pancreatitis in patients with nondiagnostic baseline imaging.

    Monachese M, Lee PJ, Harris K, et al.

    Endoscopic ultrasound 2021; (10(2)):116-123 doi:10.4103/EUS-D-20-00138.

    PMID: 33885007
  20. 20

    A study of the clinical utility of a 20-minute secretin-stimulated endoscopic pancreas function test and performance according to clinical variables.

    Lara LF, Takita M, Burdick JS, et al.

    Gastrointestinal endoscopy 2017; (86(6)):1048-1055.e2 doi:10.1016/j.gie.2017.03.1532.

    PMID: 28385584

This page explains chronic pancreatitis imaging and function tests for informational purposes only and does not constitute medical advice. Your clinician should interpret your results and recommend the next test for your situation.

Get notified when new evidence is published on chronic pancreatitis.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.