Advanced Imaging of Chronic Pancreatitis

Abstract

Chronic pancreatitis is characterized by continuing inflammation, destruction, and irreversible morphological changes in the pancreatic parenchyma and ductal anatomy. These changes lead to chronic pain and/or loss of function. Although these definitions are simple, the clinical diagnosis of chronic pancreatitis remains difficult to make, especially for early disease. Routine imaging modalities such as transabdominal ultrasound and standard CT scans are insensitive for depicting early disease, and detect only advanced chronic pancreatitis. Advances in imaging modalities including CT, MRI with gadolinium contrast enhancement, MRI with magnetic resonance cholangiopancreatography (MRI/MRCP), MRI/MRCP with secretin-stimulation (S-MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) allow earlier diagnosis of chronic pancreatitis. This article reviews the recognized findings, advantages, and disadvantages of the various imaging modalities in the management of chronic pancreatitis, specifically CT, MRI with or without MRCP and/or S-MRCP, ERCP, and EUS.

Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group

“…A number of potentially useful imaging modalities are currently available (105). Abdominal imaging with either CT or MRI are widely available and sensitive to detect complications of CP linked to structural or density changes.…”

MRI assessment of chronic pancreatitis

“…The presence of periductal fibrosis results in traction of the main pancreatic duct and its side branches, causing dilatation of the main pancreatic duct and its side branches (5)(6)(7)(8). Pancreatic ductal findings regarding chronic pancreatitis are evaluated by MRCP according to the Cambridge classification, as shown in Table. Normal pancreatic ductal anatomy, without side branch ectasias, is considered Cambridge stage 1.…”

Defining the Accuracy of Secretin Pancreatic Function Testing in Patients With Suspected Early Chronic Pancreatitis

“…Imaging findings consistent with chronic pancreatitis included the following. (i) CT: findings of parenchymal and ductal calcifications, parenchymal atrophy, dilated main pancreatic duct, and dilated side branches (11). In each patient, we evaluated the pancreas for focal or diffuse atrophy and hypertrophy (fullness).…”

“…Consequently, imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP) have reduced sensitivity for detecting early or minimal-change disease (9–11). Endoscopic ultrasound (EUS) has emerged as a sensitive and specific test for detecting chronic pancreatitis, particularly advanced disease, although its accuracy in detecting early chronic pancreatitis is still being defined (12).…”

“…Endoscopic ultrasound (EUS) has emerged as a sensitive and specific test for detecting chronic pancreatitis, particularly advanced disease, although its accuracy in detecting early chronic pancreatitis is still being defined (12). Although histology is the gold standard, it is technically difficult to obtain biopsies of pancreatic tissue safely, with a risk of acute pancreatitis, fistula, pseudocyst, or hemorrhage (11). Indirect tests of pancreatic function include measuring fat content or elastase levels in stool, but these are either nonspecific or positive only in more advanced disease (9,13).…”