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Current Gastroenterology Reports
Published in: Current Gastroenterology Reports 2/2010

01-04-2010

Advanced Imaging of Chronic Pancreatitis

Authors: Nabil Elia Choueiri, Numan Cem Balci, Samer Alkaade, Frank R. Burton

Published in: Current Gastroenterology Reports | Issue 2/2010

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Abstract

Chronic pancreatitis is characterized by continuing inflammation, destruction, and irreversible morphological changes in the pancreatic parenchyma and ductal anatomy. These changes lead to chronic pain and/or loss of function. Although these definitions are simple, the clinical diagnosis of chronic pancreatitis remains difficult to make, especially for early disease. Routine imaging modalities such as transabdominal ultrasound and standard CT scans are insensitive for depicting early disease, and detect only advanced chronic pancreatitis. Advances in imaging modalities including CT, MRI with gadolinium contrast enhancement, MRI with magnetic resonance cholangiopancreatography (MRI/MRCP), MRI/MRCP with secretin-stimulation (S-MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) allow earlier diagnosis of chronic pancreatitis. This article reviews the recognized findings, advantages, and disadvantages of the various imaging modalities in the management of chronic pancreatitis, specifically CT, MRI with or without MRCP and/or S-MRCP, ERCP, and EUS.
Literature
1.
Munoz JED: Chronic pancreatitis. In Clinical Pancreatology for Practicing Gastroenterologists and Surgeons. Edited by Munoz JED. Malden: Blackwell; 2006:180–253.
2.
• Balci NC, Bieneman BK, Bilgin M, et al.: Magnetic resonance imaging in pancreatitis. Top Magn Reson Imaging 2009, 20:25–30. This is a good review of T1 weighted findings in chronic pancreatitis.
3.
4.
Haaga JR, Alfidi RJ, Zelch MG, et al.: Computed tomography of the pancreas. Radiology 1976, 120:589–595.PubMed
5.
Shams J, Stein A, Cooperman AM: Computed tomography for pancreatic diseases. Surg Clin North Am 2001, 81:283–306.CrossRefPubMed
6.
Buscail L, Escourrou J, Moreau J: Endoscopic ultrasonography in chronic pancreatitis: a comparative prospective study with conventional ultrasonography, computed tomography, and ERCP. Pancreas 1995, 10:251–257.CrossRefPubMed
7.
• Banks P: Classification and diagnosis of chronic pancreatitis. J Gastroenterol 2007, 42(Suppl XVII):148–151. This is a good summary of the ERCP Cambridge classification for chronic pancreatitis and its revisions.
8.
Edge MD, Hoteit M, Patel AP: Clinical significance of main pancreatic duct dilatation on computed tomography: single and double duct dilatation. World J Gastroenterol 2007, 13:1701–1705.PubMed
9.
Kusano S, Kaji T, Sugiura Y, et al.: CT demonstration of fibrous stroma in chronic pancreatitis: pathologic correlation. J Comput Assist Tomogr 1999, 23:297–300.CrossRefPubMed
10.
•• Kim DH, Pickhardt PJ: Radiologic assessment of acute and chronic pancreatitis. Surg Clin North Am 2007, 87:1341–1358. This is an excellent review of currently available imaging modalities for pancreatic disease in general.
11.
Toprak O, Cirit M: Risk factors for contrast induced nephropathy. Kidney Blood Press Res 2006, 29:84–93.CrossRefPubMed
12.
Luetmer PH, Stephens DH, Ward EM: Chronic pancreatitis: reassessment with current CT. Radiology 1989, 171:353–357.PubMed
13.
Yamada Y, Mori H, Matsumoto S, et al.: Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT. Abdom Imaging 2009, in press.
14.
• Vitale JC, Davis VR, Zavaleta C, et al.: Endoscopic retrograde cholangiopancreatography and histopathology correlation for chronic pancreatitis. Am Surg 2009, 75:649–653. This is an important article which investigates the positive histopathologic correlation of ERCP in chronic pancreatitis.
15.
Etemad B, Whitcomb DC: Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 2001, 120:682–707.CrossRefPubMed
16.
Vennes JA, Silvis SE: Introduction to endoscopic retrograde cholangiopancreatography. In Text and Atlas of Endoscopic Retrograde Cholangiopancreatography. Edited by Ansel HJ. New York: Igaku-Shoin; 1995:1–21.
17.
Balthazar E. Pancreatitis. In Textbook of Gastrointestinal Radiology, vol 2. Edited by Levine M. Philadelphia: WB Saunders; 2000:1767–1795.
18.
Ly JN, Miller FH: MR imaging of the pancreas: a practical approach. Radiol Clin North Am 2002, 40:1289–1306.CrossRefPubMed
19.
Bilgin M, Bilgin S, Balci NC, et al.: Magnetic resonance imaging and magnetic resonance cholangiopancreatography findings compared with fecal elastase-1 measurement for the diagnosis of chronic pancreatitis. Pancreas 2008, 36:e33–e39.CrossRefPubMed
20.
•• Alkaade S, Balci NC, Momtahen AJ et al.: Normal pancreatic exocrine function does not exclude MRI/MRCP chronic pancreatitis findings. J Clin Gastroenterol 2008, 42:950–955. This important article highlights the high sensitivity of MRI/MRCP in the detection of chronic pancreatitis even in the face of normal exocrine function.
21.
•• Balci NC, Alkaade S, Magas L, et al.: Suspected chronic pancreatitis with normal MRCP: findings on MRI in correlation with secretin MRCP. J Magn Reson Imaging 2008, 27:125–131. This article further highlights the increased sensitivity of detection of early chronic pancreatitis using secretin stimulated MRCP even in the same of a normal regular MRCP.
22.
Hanbidge AE: Cancer of the pancreas: the best image for early detection-CT, MRI, PET, or US. Can J Gastroenterol 2002, 16:101–105.PubMed
23.
• Balci NC, Perman WH, Saglam S, et al.: Diffusion-weighted magnetic resonance imaging of the pancreas. Top Magn Reson Imaging 2009, 20:43–47. This article highlights the ability of diffusion weighted imaging and MRI in the differentiation between focal mass forming chronic pancreatitis and pancreatic cancer.
24.
• Fattahi R, Balci NC, Perman WH, et al.: Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 2009, 29:350–356. This article highlights the ability of diffusion weighted imaging and MRI in the differentiation between focal mass-forming chronic pancreatitis and pancreatic cancer.
25.
Cappeliez O, Delhaye M, Deviere J, et al.: Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology 2000, 215:358–364.PubMed
26.
Glaser J, Hogemann B, Krummener L, et al.: Sonographic imaging of the pancreatic duct. Dig Dis Sci 1987, 32:1075–1081.CrossRefPubMed
27.
Testoni PA, Mariani A, Curioni A, et al.: Pancreatic ductal abnormalities documented by secretin-enhanced MRCP in asymptomatic subjects with chronic pancreatic hyperenzymemia. Am J Gastroenterol 2009, 104:1780–1786.CrossRefPubMed
28.
Sainani NI, Conwell DL: Secretin-enhanced MRCP: proceed with cautious optimism. Am J Gastroenterol 2009, 104:1787–1789.CrossRefPubMed
29.
•• Catalano MF, Sahai A, Levy M, et al.: EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc 2009, 69:1251–1261. This is an excellent landmark article summarizing the recent EUS-based criteria for the diagnosis of chronic pancreatitis.
30.
• Rizk MK, Gerke H: Utility of endoscopic ultrasound in pancreatitis: a review. World J Gastroenterol 2007, 13:6321–6326. This article is a good review of EUS criteria for the diagnosis of chronic pancreatitis.
31.
Sahai AV, Zimmerman M, Aabakken L, et al.: Prospective assessment of the ability of endoscopic ultrasound to diagnose, exclude, or establish the severity of chronic pancreatitis found by endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 1998, 48:18–25.CrossRefPubMed
32.
• Varadarajulu S, Eltoum I, Tamhane A, et al.: Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study. Gastrointest Endosc 2007, 66:501–509. This article is important because it shows the positive correlation between histopathology and EUS criteria in the diagnosis and staging of chronic pancreatitis.
33.
Morris-Stiff G, Webster P, Frost B, et al.: Endoscopic ultrasound reliably identifies chronic pancreatitis when other imaging modalities have been non-diagnostic. J Pancreas (Online) 2009, 10:280–283.
34.
Agarwal B, Krishna NB, Labundy JL, et al.: EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointest Endosc 2008, 68:237–242.CrossRefPubMed
35.
Krishna NB, Labundy JL, Saripalli S, et al.: Diagnostic value of EUS-FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Pancreas 2009, 38:625–630.CrossRefPubMed
Metadata
Title
Advanced Imaging of Chronic Pancreatitis
Authors
Nabil Elia Choueiri
Numan Cem Balci
Samer Alkaade
Frank R. Burton
Publication date
01-04-2010
Publisher
Current Science Inc.
Published in
Current Gastroenterology Reports / Issue 2/2010
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-010-0093-4

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