Imaging of acute pancreatitis and its complications. Part 1: Acute pancreatitis

Abstract

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

A glance at Acute Pancreatitis (AP)

“…US is the basic imaging modality in most centers to confirm the diagnosis of AP and ruling out of other causes of acute abdomen [45], yet, sometimes of limited value [44]. US shows focally or diffusely enlarged hypoechoic pancreatic gland.…”

Pancréatite aiguë : le scanner n’attend pas

“…Dans ce numéro de formation médicale continue, Türkvatan et al présentent un excellent aperçu des aspects tomodensitométriques (TDM) variés de la pancréatite aiguë (PA) et de ses complications potentielles [1,2]. Il n'y a actuellement aucun doute sur le fait que la TDM est l'examen d'imagerie clé dans le domaine de la PA. Ceci est conforté par une importante quantité de données présentes dans la littéra-ture médicale scientifique [3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Dans leurs articles, Türkvatan et al ont abordé le rôle de l'IRM dans le diagnostic de PA [1,2]. Jusqu'à présent, plusieurs études ont montré que l'IRM est un outil utile pour le diagnostic de PA et est équivalente [19,20] ou surpasse même la TDM [8] pour évaluer la gravité de la maladie.…”

CT of acute pancreatitis: A matter of time

“…In this issue of Diagnostic and Interventional Imaging, Türkvatan and colleagues present a nice overview of the computed tomography (CT) features of acute pancreatitis (AP) and its potential complications [1,2]. There is currently no doubt upon the fact that CT is the key imaging test in the area of AP.…”

“…In their papers, Türkvatan et al have addressed the role of MR imaging for the diagnosis of AP [1,2]. So far, several studies have showed that MR imaging is a useful tool for the diagnosis of AP and is equivalent to [19,20] or even surpasses CT [8] for evaluating the severity of the disease.…”