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European Radiology
Published in: European Radiology 2/2015

01-02-2015 | Gastrointestinal

Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings

Authors: Riccardo Negrelli, Riccardo Manfredi, Beatrice Pedrinolla, Enrico Boninsegna, Anna Ventriglia, Sara Mehrabi, Luca Frulloni, Roberto Pozzi Mucelli

Published in: European Radiology | Issue 2/2015

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Abstract

Aim

To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis.

Methods

MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement.

Results

Signal intensity abnormalities were localized in the head in 10/26 (38.5 %) and in the body-tail in 16/26 (61.5 %) patients. MRCP showed a single MPD stenosis in 12/26 (46.1 %) and multiple MPD stenosis in 14/26 (53.8 %) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6 %) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2 %) patients with contrast retention.

Conclusions

MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma.

Key Points

• MRI represents the gold standard in the diagnosis of AIP.
• MRCP is an increasingly useful technique in the diagnosis of focal AIP.
• MRCP could be a problem-solving tool in the differential diagnosis of AIP.
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Metadata
Title
Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings
Authors
Riccardo Negrelli
Riccardo Manfredi
Beatrice Pedrinolla
Enrico Boninsegna
Anna Ventriglia
Sara Mehrabi
Luca Frulloni
Roberto Pozzi Mucelli
Publication date
01-02-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3371-y

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