<b>MRI of Pancreatitis and Its Complications:</b> Part 2, Chronic Pancreatitis

Miller, Frank H.; Keppke, Ana L.; Wadhwa, Anubha; Ly, John N.; Dalal, Kshitij; Kamler, Vilim Alan

doi:10.2214/ajr.183.6.01831645

Cited by 60 publications

(22 citation statements)

References 7 publications

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“…Chronic pancreatitis diminishes proteinaceous content in the parenchyma, which manifests as diffusely low T 1 signal on MRI. 11 The enhancement patterns show decreased arterial enhancement, with relative increased delayed enhancement on later phase post-contrast sequences. 12 – 16 With the exception of the more discrete tumours found in our case, the T 1 signal and enhancement pattern of the pancreas was relatively normal.…”

Section: Discussionmentioning

confidence: 98%

Imitators of chronic pancreatitis: diffuse neuroendocrine tumour of the pancreas

et al. 2017

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We report a rare case of diffuse replacement of the pancreas with neuroendocrine tumour mimicking chronic pancreatitis. A 55-year-old female with no significant past medical history initially presented with abdominal pain in 2006. A CT of the abdomen and pelvis was performed, revealing diffuse pancreatic parenchymal calcifications with mild pancreatic ductal dilatation and no discrete mass. She was diagnosed with chronic pancreatitis and followed clinically until 2015, where she presented with recurrent abdominal pain. A repeat CT and MRI of the abdomen were performed which revealed new hypoenhancing masses within the pancreas, particularly in the pancreatic tail. There was a persistent background of pancreatic parenchymal calcifications. The possibility of pancreatic neuroendocrine tumour was raised, and an indium-111 Octreotide scan was recommended. Diffuse intense uptake was identified throughout the pancreas on the indium-111 imaging. Given the concern for neuroendocrine tumour, a total pancreatectomy was performed, with histopathology revealing replacement of the pancreas with coalescing well-circumscribed nodules. Many of the nodules had numerous calcifications and localized amyloid deposition. Immunohistochemical stains of the neoplastic cells were strong for neuroendocrine markers chromogranin A and synaptophysin. Overall the findings were consistent with numerous neuroendocrine tumours of the pancreas, Grade II, as per the 2010 WHO criteria for neuroendocrine tumours of the pancreas. Neuroendocrine tumours of the pancreas are lesions that arise from the islet cells, with an approximate incidence of five cases per million people per year. Only one other case report has been documented in the literature by Singh et al demonstrating diffuse pancreatic neuroendocrine tumour replacing the entire pancreas. As diffuse pancreatic neuroendocrine tumour can look similar on imaging to chronic pancreatitis or other infiltrative processes, we wanted to present this case and some of the more specific imaging findings in distinguishing these entities.

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Section: Discussionmentioning

confidence: 98%

Imitators of chronic pancreatitis: diffuse neuroendocrine tumour of the pancreas

et al. 2017

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“…Because of low-signal-intensity of the pancreas with severe CP on T 1 -weighted fat-suppressed images (28), the baseline value of the SI of the SI-T curve could decrease in severe CP. Moreover, the SI-T curves were plotted with the absolute SI values of the pixels, so the baseline SI value of the of SI-T curve could be different among piglets.…”

Section: Discussionmentioning

confidence: 99%

DCE‐MRI in experimental chronic pancreatitis

Shu

Zhang

Zhao

et al. 2009

Contrast Media & Molecular

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To assess pancreatic perfusion in experimental chronic pancreatitis (CP) by dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). DCE MRI on a 1.5 T MR scanner was performed on 21 piglets with the ligation of pancreatic duct. They were divided into four groups based on pathology, including seven normal pigs and seven, three and four piglets with grade I, II and III CP, respectively. The signal intensity measured in the pancreatic body on DCE MRI was plotted against time to create a signal intensity-time (SI-T) curve for each piglet. The steepest slope (SS), time-to-peak (TTP) and peak enhancement ratio (PER) of the SI-T curve were noted. In the four groups, on the SI-T curve derived from DCE MRI, the SS was, respectively, 10. and TTP (r ¼ 0.538, p ¼ 0.012) of the SI-T curve was correlated to the severity of CP, respectively. DCE MRI has a potential to diagnose moderate to advanced CP. The SS and TTP of the SI-T curve were correlated to the severity of CP.

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“…However, its association with chronic pancreatitis remains controversial. Duct abnormalities such as dilatation, irregularity and stones and complications of chronic pancreatitis such as pseudocysts are best depicted by thin section T2W HASTE or SSFSE and thick slab T2W Half Fourier RARE MRCP images [100] .…”

Section: Mildmentioning

confidence: 99%

MR Cholangio-Pancreaticography as a Tool for Evaluation of Patients With Pancreaticobiliary Diseases

Nadaf¹,

ijar²,

C.P³

et al. 2020

IJAR

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Objectives Of Study: 1. To describe features of pancreaticobiliary diseases on MRCP. 2. Outlining the extent in terms of involvement of adjacent structures, vesselsâ€¨and soft tissues. â€¨ 3. To help in deciding further course of management. 4. To identify the anatomical variants. â€¨ 5. To prove the Magnetic Resonance Cholangio-Pancreatography (MRCP) isâ€¨one of the best imaging modality for evaluation of pancreatico-biliary disease. Material And Methods:The present study was undertaken to evaluate the role of MRCP in evaluation of pancreaticobiliary diseases. The study will be done on patients presenting with features suggestive of pancreatico-biliary diseases attending the OPD or admitted in various wards of Krishna Rajendra hospital, Mysore attached to Mysore Medical College & Research Institute, Mysore. A total of 30 patients were included in our study. Result:Majority of patients in study population were males (60%) while 40% were females. The mean age of the study sample was 37.5 years and maximum numbers of cases were observed in age group of > 40 years. Majority of pathologies observed were benign 18(60%). Pancreatitis was the most common finding (33.3%) followed by Cholangiocarcinoma (20%), Choledocholithiasis (13.4%), Periampullary carcinoma (10%), Ca. Pancreas (6.7%) & Choledochal cyst (6.7%).Pancreatitis is common in males followed by Cholangiocarcinoma, which is common in both males & females.Both benign & malignant strictures have equal predominance. Both benign & malignant strictures are common in proximal CBD. Conclusion: MRCP is non-invasive, non-ionizing imaging method for evaluation of pancreatico-biliary anatomy and pathology. It is superior diagnostic modality in detection and characterization of pancreatico-biliary pathologies.

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MRI of Pancreatitis and Its Complications: Part 2, Chronic Pancreatitis

Cited by 60 publications

References 7 publications

Imitators of chronic pancreatitis: diffuse neuroendocrine tumour of the pancreas

Imitators of chronic pancreatitis: diffuse neuroendocrine tumour of the pancreas

DCE‐MRI in experimental chronic pancreatitis

MR Cholangio-Pancreaticography as a Tool for Evaluation of Patients With Pancreaticobiliary Diseases

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