Ultrasonographic Imaging of Bile Duct Lesions in Autoimmune Pancreatitis

Koyama, Rikako; Imamura, Tsunao; Okuda, Chikao; Sakamoto, Natsuko; Honjo, Hajime; Takeuchi, Kazuo

doi:10.1097/mpa.0b013e31816b30e7

Cited by 37 publications

(13 citation statements)

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“…Characteristic bile duct and gallbladder wall thickening was recognized on abdominal ultrasound in 14 (37.8%) of 37 AIP patients. All 14 patients were treated with prednisolone, and this led to immediate resolution of the bile duct lesions [27]. Hyodo et al reported that concentric thickening of the distal common bile duct wall and its strong enhancement by Levovist was a characteristic feature on endoscopic ultrasonography (EUS) (Fig.…”

Section: Ultrasonographymentioning

confidence: 99%

“…An association with characteristic right-dominant IBD is suggestive of PSC [23]. If a type 3 or 4 cholangiogram is obtained, cholangiocarcinoma should be discriminated from IgG4-SC by findings of US [27], including EUS [28] or IDUS [29]. The most characteristic IDUS finding in cases of IgG4-SC is wall thickening in areas of the bile duct that do not appear stenotic in the cholangiogram, to allow discrimination from cholangiocarcinoma.…”

Section: Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic procedures for IgG4-related sclerosing cholangitis

Nakazawa

Ando

Hayashi

et al. 2010

Journal of Hepato-Biliary-Pancreatic Sciences

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Section: Ultrasonographymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Diagnostic procedures for IgG4-related sclerosing cholangitis

Nakazawa

Ando

Hayashi

et al. 2010

Journal of Hepato-Biliary-Pancreatic Sciences

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“…Because the MRCP can show diffuse thinning of main pancreatic duct [55], non-visualization of the main pancreatic duct on MRCP might suggest narrowing of the main pancreatic duct. Electronic endoscopy may be a useful adjunct to differentiate concentric bile duct thickening (more commonly seen in AIP) from strictures caused by extrinsic compression as seen in pancreatic cancer [56]–[57]. Kamisawa et al [58] believed that MRCP (1.5 T) could not be used as a substitute for ERCP in the diagnosis of AIP but might be employed for follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinical Analysis of 36 Cases of Autoimmune Pancreatitis in China

Zhang

Li³

et al. 2012

PLoS ONE

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BackgroundTo improve the early identification of autoimmune pancreatitis in China by a retrospective analysis of clinical data from AIP patients.Methodology/Principal FindingsThe analysis included 36 patients admitted by the surgery department of our hospital from January 2003 to October 2011 whose postoperative pathological confirmations were consistent with the histological criteria of Honolulu Consensus Document. The clinical phenotypes associated with the histopathologic patterns of LPSP and IDCP were referred to as type 1 and type 2 of AIP, respectively. A retrospective analysis of clinical features, serological data, pathological findings and imageological records was performed in line with the subtypes of AIP. Type 1 showing a sex predilection (males) was commonly more dominant than type 2 in all AIP. Type 2 without a gender predilection was, on average, a decade younger than type 1. Type 1 was inferior to type 2 in ALT, ALP and γ-GT with statistical significance (P = 0.044, 0.025 and 0.013). Type 1 was inferior to type 2 in AST with difference close to statistical significance (P = 0.072). Histopathology revealed frequent lymphoplasmacytic infiltration with less frequent infiltration of neutrophils, eosinophils and fibroblasts. Diffuse and intensive interstitial fibrosis could be seen. The changes of pancreatic head were more frequently seen in type 2 than in type 1 (P = 0.05). Plasma cells staining of IgG4 at a density of over 30 or more cells per high-power field appeared to be a specific finding in China with type 1. Imageology found a diffusely or focally enlarged pancreas, most frequently a mass or enlargement in the pancreatic head, characteristic capsule-like rim, calcification or pancreatic calculus and cystic degeneration.Conclusions/SignificanceAIP is a unique type of chronic pancreatitis and has distinctive serological, pathological and imageological characteristics, which should be used for differentiation from pancreatic cancer.

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“…Endoscopic ultrasound may be a useful adjunct to differentiate concentric bile duct thickening (more commonly seen in AIP and responsive to steroids) from strictures caused by extrinsic compression as seen in pancreatic cancer [42,43]. EUS-guided fine-needle aspiration (FNA) biopsies can confirm the diagnosis of AIP and were performed on 22 of the 23 patients in our study to exclude pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%