Imaging of inflammatory disease of the pancreas

Abstract

Increasingly acute and chronic pancreatitis (AP and CP) are considered a continuum of a single entity. Nonetheless, if, after flare-up, the pancreas shows no residual inflammation, it is classified as AP. CP is characterised by a long cycle of worsening and waning glandular inflammation without the pancreas ever returning to its baseline structure or function. According to the International Consensus Guidelines on Early Chronic Pancreatitis, pancreatic inflammation must last at least 6 months before it can be labelled CP. The distinction is important because, unlike AP, CP can destroy endocrine and exocrine pancreatic function, emphasising the importance of early diagnosis. As typical AP can be diagnosed by clinical symptoms plus laboratory tests, imaging is usually reserved for those with recurrent, complicated or CP. Imaging typically starts with ultrasound and more frequently with contrast-enhanced computed tomography (CECT). MRI and/or MR cholangiopancreatography can be used as a problem-solving tool to confirm indirect signs of pancreatic mass, differentiate between solid and cystic lesions, and to exclude pancreatic duct anomalies, as may occur with recurrent AP, or to visualise early signs of CP. MR cholangiopancreatography has replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP). However, ERCP, and/or endoscopic ultrasound (EUS) remain necessary for transpapillary biliary or pancreatic duct stenting and transgastric cystic fluid drainage or pancreatic tissue sampling, respectively. Finally, positron emission tomography-MRI or positron emission tomography-CT are usually reserved for complicated cases and/or to search for extra pancreatic systemic manifestations. In this article, we discuss a broad spectrum of inflammatory pancreatic disorders and the utility of various modalities in diagnosing acute and chronic pancreatitis.

An incidental finding behind adrenal incidentaloma

“…The latter within 4 weeks from the beginning of the disease may show the presence of acute necrotic collections which could be intra- or extra-pancreatic ( 1 , 3 ). These necrotic collections at conventional imaging (CT and MRI) are inhomogeneous fluid collections containing solid tissue which could become walled-off necrosis with thick contrast-enhanced walls ( 4 ).…”

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

“…MRI, a noninvasive technology boasting high tissue contrast and multiple acquisition sequences, effectively aids in determining the diagnosis, complications, and severity of AP[ 36 ]. When CT yields negative results but there remains a strong clinical suspicion of AP, fat-saturated turbo spin echo T2-weighted or diffusion-weighted imaging sequences can reveal nuanced pancreatic and/or peripancreatic inflammation[ 73 ]. MRI holds a pivotal role in the diagnosis of AP and is instrumental in assessing and characterizing extrapancreatic necrosis, inflammation, splenomegaly, and tissue involvement, including vascular, transverse-mesocolon, interfascial plane, and the gastrointestinal tract, in AP patients[ 21 , 74 - 80 ].…”