Role of Imaging Methods in Diagnosing, Staging, and Detecting Complications of Chronic Pancreatitis in Clinical Practice: Should MRCP and MRI Replace ERCP and CT?

Villalba-Martín, Carmen; Domínguez‐Muñoz, J. Enrique

doi:10.1002/9780470987506.ch28

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Its good correlation with ERCP has been demonstrated, and it seems likely to become a promising alternative to diagnostic ERCP. [6][7][8][9] Imaging features of early chronic pancreatitis shown by MRCP are similar to those obtained by ERCP and include side-branch ectasia, mild ductal dilatation, loss of the normal gentle tapering of the duct toward the tail, and mural irregularities (Fig. 2).…”

Section: Evaluation Of the Ductal Systemmentioning

confidence: 69%

“…It has been claimed that the results of MRI and MRCP correlate well with those of computed tomography and ERCP, which makes MRCP a promising alternative to diagnostic ERCP. [6][7][8][9] The administration of secretin improves ductal delineation and may allow an indirect estimation of the exocrine pancreatic function. Secretin (S)-MRCP provides parenchymal, ductal, and functional information within a single diagnostic modality for the comprehensive examination of the pancreas.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography

Czakó

2007

J Gastroenterol

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A diagnostic means of detecting chronic pancreatitis at an early stage, when the disease is still reversible, needs to be developed. Magnetic resonance cholangiopancreatography (MRCP) has recently been evolving as an important tool for the evaluation of chronic pancreatitis. In patients with moderate chronic pancreatitis, the pancreatic parenchyma displays an abnormal enhancement pattern on T1-weighted sequences after gadolinium administration. The presence of a signal intensity ratio of <1.7 in the arterial phase and/or delayed peak enhancement after contrast administration has a sensitivity of 92% and a specificity of 75% for the demonstration of early chronic pancreatitis. The secretin-induced pancreatic T2 signal intensity changes are significantly reduced in patients with a mild exocrine pancreatic insufficiency as compared with healthy volunteers. MRCP visualizes fluid in the pancreatic and biliary ducts as high signal intensity on heavily T2-weighted sequences. However, visualization of normal or minimally dilated pancreatic ducts by MRCP is more challenging because of their small size. Secretin administration stimulates fluid and bicarbonate secretion by the exocrine pancreas; consequently, it improves the pancreatic duct and side-branch delineation and allows an evaluation of the exocrine pancreatic function. Side-branch ectasia, mild ductal dilatation with loss of the normal gentle taper, and mural irregularities are the pathognomonic MRCP features of early-stage chronic pancreatitis. Through measurement of the duodenal filling, secretin-MRCP allows quantitative assessment of the exocrine pancreatic function, even in patients with a mild exocrine insufficiency. The morphology of the pancreatic ducts, particularly in the early stages, does not always correlate with the functional status. MRCP permits visualization of the ductal changes and furnishes functional information on the pancreas; this combination may enhance its diagnostic accuracy so that MRCP can become a valuable diagnostic means in early-stage chronic pancreatitis.

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Section: Evaluation Of the Ductal Systemmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography

Czakó

2007

J Gastroenterol

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“…In general, the classifi cation is based on current knowledge of the etiology of chronic pancreatitis (reviewed by Etemad and Whitcomb 13 and Lankisch and Banks 40 ), epidemiological studies, [41][42][43][44][45][46][47][48] clinical long-term observations of the natural course of the disease, [1][2][3][4][5]10,46,[49][50][51][52] hypothetical concepts of the development of chronic pancreatitis, 7,9,53-57 recent genetic fi ndings, 6,58-77 insights gained from experimental studies and investigations revealing the mechanisms of fi brotic destruction of the organ, [15][16][17][18][78][79][80][81] and studies dealing with pancreatic imaging techniques. [28][29][30][82][83][84][85][86][87][88][89][90] …”

Section: Review Of the Literature In Support Of The M-annheim Classifmentioning

confidence: 99%

“…[86][87][88]90 The MRI technique is helpful in detecting early signs of chronic pancreatitis, 88 and MRCP after secretin stimulation improves visualization of the pancreatic main duct and pancreatic duct side branches, thereby providing signifi cant support in the detection of early and mild changes of chronic pancreatitis. 87 In general, morphologic fi ndings of chronic pancreatitis on MRI/MRCP are analogous to those seen on CT. 90 However, no consensus exists concerning the grading of MRI/MRCP imaging according to the Cambridge criteria.…”

Section: M-annheim Imaging Criteria Of the Pancreas Based On The Cambmentioning

confidence: 99%

The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease

2007

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The M-ANNHEIM multiple risk factor classification system is simple, objective, accurate, and relatively noninvasive, and it incorporates etiology, different stages of the disease, and various degrees of clinical severity. This new classification system will be helpful for investigating the impact and interaction of various risk factors on the course of the disease and will facilitate the comparison and combination of interinstitutional data.

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Diagnosis: Functional Testing, Radiological Work-up of Chronic Pancreatitis

Kahl

Keller

Layer

Diseases of the Pancreas

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Role of Imaging Methods in Diagnosing, Staging, and Detecting Complications of Chronic Pancreatitis in Clinical Practice: Should MRCP and MRI Replace ERCP and CT?

Cited by 4 publications

References 27 publications

Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography

Diagnosis of early-stage chronic pancreatitis by secretin-enhanced magnetic resonance cholangiopancreatography

The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease

Diagnosis: Functional Testing, Radiological Work-up of Chronic Pancreatitis

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