Autoimmune Pancreatitis: Possibilities of CT Characterization

Procacci, Carlo; Carbognin, Giovanni; Biasiutti, Carlo; Frulloni, Luca; Bicego, E.; Spoto, Elide; Elkhaldi, Mousa; Bassi, Claudio; Pagnotta, Nicoletta; Talamini, Giorgio; Cavallini, Giorgio

doi:10.1159/000055819

Cited by 68 publications

(39 citation statements)

References 16 publications

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“…Actually, at initial FDG-PET, extrapancreatic lesions were recognized in 85% of this series. Clinical images such as US [29,30] , CT [31][32][33] , EUS [29,34] and MRI [33] have been widely used for evaluating AIP. However, many of these reports focused on the pancreatic lesion, but not systemic complications.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Positron Emission Tomography in the Evaluation of Distribution and Activity of Systemic Lesions Associated with Autoimmune Pancreatitis

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Usefulness of Positron Emission Tomography in the Evaluation of Distribution and Activity of Systemic Lesions Associated with Autoimmune Pancreatitis

et al. 2009

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“…Recent reviews have described the currently available clinical, immunological, radiological and morphological features [19,26,28,30]. Clinically, it is a heterogeneous disease that can present with either the classical symptoms of acute or severe pancreatitis or with obstructive jaundice due to a mass in the head of the pancreas mimicking pancreatic ductal carcinoma [6,16,28].…”

Section: Introductionmentioning

confidence: 99%

Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens

et al. 2004

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Background and Aims: Autoimmune pancreatitis seems to be a disease with a heterogeneous appearance. Our intention was to establish key diagnostic criteria, define grades of severity and activity, identify features of potential subtypes and evaluate the diagnostic relevance of biopsy specimens. Methods: Histopathological criteria and clinical features were recorded in pancreatic resection specimens from 53 patients who were found to have chronic pancreatitis lacking pseudocysts, calculi, irregular duct dilatations, pancreas divisum and/or duodenal wall inflammation. The severity of the chronic inflammation was graded, and the activity of the acute inflammatory component and the granulocytic epithelial lesion (GEL) were determined. Additionally, pancreatic biopsy specimens from 9 patients with suspected AIP were assessed. Results: Periductal lymphoplasmacytic infiltration was identified in all cases, followed in order of frequency by periductal fibrosis and venulitis. These changes were absent in 147 pancreatic specimens that showed chronic pancreatitis associated with pseudocysts, calculi, pancreas divisum and/or duodenal wall inflammation. In 90% of the cases, these chronic changes were graded as 3 or 4. In 81%, the inflammatory process resided in the head of the pancreas and involved the common bile duct. GELs were present in 42% of the patients, who had a mean age of 40.5 years, an almost equal male-female ratio and a high coincidence of ulcerative colitis or Crohn's disease. Patients without GELs were older (mean age 64 years), showed a male preponderance, commonly had Sjögren's syndrome and often developed recurrent bile-duct stenosis. Diagnostically relevant lesions were present in two of five wedge biopsy specimens and three of four fine-needle specimens. Conclusions: Periductal lymphoplasmacytic infiltration and fibrosis, preferential occurrence in the pancreatic head and venulitis characterize autoimmune pancreatitis. GELs predominantly occur in a subset of patients who are younger, more commonly have ulcerative colitis and Crohn's disease and seem to have fewer recurrences than patients without GELs. Pancreatic biopsy material proved to be a very helpful adjunct for establishing the diagnosis.

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“…Published Japanese, Korean and American diagnostic criteria [20,21,22] are based on the combination of clinical, histological and laboratory changes, and in some cases the response to steroids. Imaging features used in these diagnostic criteria include endoscopic retrograde cholangiopancreatography (ERCP), ultrasound, CT and MRI signs: diffuse or segmental narrowing of the main pancreatic duct (MPD), focal or diffuse enlargement (swelling) of the pancreas and additionally in US criteria a delayed enhancement of the pancreas, atrophy, calcifications and pancreatitis.…”

Section: Introductionmentioning

confidence: 99%