Pancreatic Duct Patterns in Acute Pancreatitis: A MRI Study

Abstract

ObjectivesTo study the MRI findings of the pancreatic duct in patients with acute pancreatitis.Materials and MethodsA total of 239 patients with acute pancreatitis and 125 controls were analyzed in this study. The severity of acute pancreatitis was graded using the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation II(APACHE II) scoring systems. The number of main pancreatic duct (MPD) segments visualized, and both MPD diameter and pancreatic duct disruption were noted and compared with the severity of acute pancreatitis.ResultsThe frequency of MPD segment visualization in the control group was higher than that in the acute pancreatitis group (p<0.05). The number of MPD segments visualized was negatively correlated with the MRSI score (p<0.05) and the APACHE II score (p<0.05). There was no difference in the MPD diameter between the acute pancreatitis and control groups or among the patients with different severities of acute pancreatitis (p>0.05). The prevalence of pancreatic duct disruption was 7.9% in the acute pancreatitis group. The prevalences of pancreatic duct disruption were 4.8% and 15.3% in the mild and severe acute pancreatitis groups based on the APACHE II score, respectively, and were 0%, 5.7% and 43.5% in the mild, moderate and severe acute pancreatitis groups according the MRSI score, respectively. The prevalence of pancreatic duct disruption was correlated with the severity of acute pancreatitis based on the APACHE II score (p<0.05) and MRSI score (p<0.05).ConclusionThe pancreatic duct in acute pancreatitis patients was of normal diameter. The number of MPD segments visualized and visible pancreatic duct disruption on MRI may be supplementary indicators for determining the severity of acute pancreatitis.

ACR Appropriateness Criteria® Acute Pancreatitis

“…MRI Abdomen. MRI abdomen without and with IV contrast with MRCP has comparable diagnostic and prognostic value to CT abdomen without and with IV contrast in AP [22] and can be used to assess the severity of AP and its local complications. An MRI severity index based on the degree of pancreatic and peripancreatic fluid and the extent of pancreatic necrosis significantly correlates with CT severity index, the clinical variables associated with the severity of AP, and the clinical outcome [22].…”

“…MRI abdomen without and with IV contrast with MRCP has comparable diagnostic and prognostic value to CT abdomen without and with IV contrast in AP [22] and can be used to assess the severity of AP and its local complications. An MRI severity index based on the degree of pancreatic and peripancreatic fluid and the extent of pancreatic necrosis significantly correlates with CT severity index, the clinical variables associated with the severity of AP, and the clinical outcome [22]. Local complications seen on MRI in the acute period (48-72 hours after symptom onset), such as pararenal space involvement, gallbladder abnormalities, and visible pancreatic duct disruption, correlate with the severity of AP according to MRI severity index and may be supplementary signs of AP severity [22][23][24].…”

“…Fluid-sensitive MRI sequences, including T2-weighted imaging and MRCP, are superior to CT for depiction of necrotic debris within fluid collections [21,26], and MRI with MRCP is well suited for evaluation of pancreatic duct disruption, which most commonly occurs as a complication of necrotizing pancreatitis [22]. Necrosis (typically of the central gland) may lead to an isolated, functional, upstream pancreatic segment that is not connected to the downstream pancreatic duct.…”

MR imaging for acute pancreatitis: the current status of clinical applications

“…Our previous study showed that as the severity increases, the incidence of pancreatic duct rupture also increases. The development of a disruption and a ruptured pancreatic duct on the MRI scan can be another credible indicator of the severity of acute pancreatitis (43), and the severity determines the clinical treatment method and predicts the short-term and long-term complications.…”

“…The greater the flexion of the main pancreatic duct, the greater the possibility of the occurrence of AP. The incidence of pancreatic duct rupture increases with the severity of AP and can be used as another simple auxiliary index to assess and predict the severity of AP (43). In terms of clinical treatment, surgical indications and the timing of the surgery are important for patients who require surgical intervention.…”