The role of apparent diffusion coefficient value in the diagnosis of localized type 1 autoimmune pancreatitis: differentiation from pancreatic ductal adenocarcinoma and evaluation of response to steroids
“…On diffusion-weighted images, the presence of highly cellular plasmocyte proliferation is reflected in a homogeneously hyperintense signal of the affected areas, with the mean apparent diffusion coefficient of the lesions being significantly lower in mass-forming AIP than in PDAC[ 52 - 54 ].…”
Section: Radiological Presentationmentioning
confidence: 99%
“…Finally, regarding the natural history of the disease, the typical picture of AIP described above usually improves after steroid treatment: the swelling of the pancreas decreases, the capsular rim disappears, the multiple MPD stenoses improve, and the enhanced duct sign also disappears. Nevertheless, the global CE of the previously affected parenchyma may not completely normalize[ 54 , 70 ]. Table 2 resembles the main radiological features of AIP.…”
Section: Endoscopic Ultrasound Presentation and Endoscopic Ultrasound...mentioning
Autoimmune pancreatitis (AIP) is an autoimmune subtype of chronic pancreatitis resulting from the aberrant immune response against the pancreas, leading to inflammation and fibrosis. Although AIP is rare, its incidence is increasing and is often misdiagnosed as other pancreatic diseases. AIP is commonly classified into two types. Type 1 AIP (AIP-1) is typically associated with elevated serum immunoglobulin G4 (IgG4) levels and systemic manifestations, while type 2 AIP is typically a more localized form of the disease, and may coexist with other autoimmune disorders, especially inflammatory bowel diseases. Additionally, there is emerging recognition of a third type (type 3 AIP), which refers to immunotherapy-triggered AIP, although this classification is still gaining acceptance in medical literature. The clinical manifestations of AIP mainly include painless jaundice and weight loss. Elevated serum IgG4 levels are particularly characteristic of AIP-1. Diagnosis relies on a combination of clinical, laboratory, radiological, and histological findings, given the similarity of AIP symptoms to other pancreatic disorders. The mainstay of treatment for AIP is steroid therapy, which is effective in most cases. Severe cases might require additional imm-unosuppressive agents. This review aims to summarize the current knowledge of AIP, encompassing its epidemiology, etiology, clinical presentation, diagnosis, and treatment options. We also address the challenges and controversies in diagnosing and treating AIP, such as distinguishing it from pancreatic cancer and managing long-term treatment, highlighting the need for increased awareness and knowledge of this complex disease.
“…On diffusion-weighted images, the presence of highly cellular plasmocyte proliferation is reflected in a homogeneously hyperintense signal of the affected areas, with the mean apparent diffusion coefficient of the lesions being significantly lower in mass-forming AIP than in PDAC[ 52 - 54 ].…”
Section: Radiological Presentationmentioning
confidence: 99%
“…Finally, regarding the natural history of the disease, the typical picture of AIP described above usually improves after steroid treatment: the swelling of the pancreas decreases, the capsular rim disappears, the multiple MPD stenoses improve, and the enhanced duct sign also disappears. Nevertheless, the global CE of the previously affected parenchyma may not completely normalize[ 54 , 70 ]. Table 2 resembles the main radiological features of AIP.…”
Section: Endoscopic Ultrasound Presentation and Endoscopic Ultrasound...mentioning
Autoimmune pancreatitis (AIP) is an autoimmune subtype of chronic pancreatitis resulting from the aberrant immune response against the pancreas, leading to inflammation and fibrosis. Although AIP is rare, its incidence is increasing and is often misdiagnosed as other pancreatic diseases. AIP is commonly classified into two types. Type 1 AIP (AIP-1) is typically associated with elevated serum immunoglobulin G4 (IgG4) levels and systemic manifestations, while type 2 AIP is typically a more localized form of the disease, and may coexist with other autoimmune disorders, especially inflammatory bowel diseases. Additionally, there is emerging recognition of a third type (type 3 AIP), which refers to immunotherapy-triggered AIP, although this classification is still gaining acceptance in medical literature. The clinical manifestations of AIP mainly include painless jaundice and weight loss. Elevated serum IgG4 levels are particularly characteristic of AIP-1. Diagnosis relies on a combination of clinical, laboratory, radiological, and histological findings, given the similarity of AIP symptoms to other pancreatic disorders. The mainstay of treatment for AIP is steroid therapy, which is effective in most cases. Severe cases might require additional imm-unosuppressive agents. This review aims to summarize the current knowledge of AIP, encompassing its epidemiology, etiology, clinical presentation, diagnosis, and treatment options. We also address the challenges and controversies in diagnosing and treating AIP, such as distinguishing it from pancreatic cancer and managing long-term treatment, highlighting the need for increased awareness and knowledge of this complex disease.
“…Sekito et al investigated the usefulness of ADC values in differentiating type 1 localized AIP from PDAC and further determining the therapeutic effect. They reported that the mean ADC values of the lesions were significantly lower in AIP than in PDAC and were elevated considerably after steroid treatment [ 29 ]. Fig.…”
Autoimmune pancreatitis (AIP) is a pancreatic phenotype of IgG4-related systemic disease. Since its first description in the literature, characteristic imaging features have gradually become known to many clinicians encompassing various specialties in the past quarter century. CT and MRI have been the workhorses for imaging diagnosis of AIP. Typical features include sausage-like swelling of the focal or entire pancreas, duct-penetrating sign, a capsule-like rim of the affected lesions, and homogeneous delayed enhancement or enhanced duct sign after contrast administration, as well as characteristic combined findings reflecting coexisting pathologies in the other organs as a systemic disease. In this review, recent and future developments in CT and MRI that may help diagnose AIP are discussed, including restricted diffusion and perfusion and increased elasticity measured using MR.
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