Chronic pancreatitis other imaging findings
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Other imaging findings
Other Imaging Findings
Other imaging findings may include:
MRCP:
- The diagnostic study of choice.
- Secretin-enhanced MRCP use has been increased recently for the early diagnosis of chronic pancreatitis.
- Findings suggestive of chronic pancreatitis may include:
- Calcifications
- Pancreatic duct obstruction
- It involves no radiation risk.
Endoscopic retrograde cholangiopancreatography (ERCP):
- ERCP is usually done when there is no evidence of
- Calcifications on imaging
- Steatorrhea
- Findings diagnostic of chronic pancreatitis may include:
- Beaded appearance of the main pancreatic duct
- Ectatic side branches from the main pancreatic duct
- According to Cambridge classification, patients are divided into 3 categories on the basis of ductal changes seen on ERCP[1][2]
Cambridge classification | Ductal changes seen on ERCP |
---|---|
Cambridge I | Equivocal changes |
Cambridge II | Mild to moderate changes |
Cambridge III | Considerable changes |
Endoscopic ultrasonography (EUS):
- EUS is equally sensitive to ERCP and pancreatic function testing but the procedure requires high skill and usually performed by a skilled gastroenterologist.[3][4][5][6]
- Presence of stones is the most predictive finding seen on EUS.
- Other findings suggestive of chronic pancreatitis may include:
- Visible side branches
- Cysts
- Lobularity
- An irregular main pancreatic duct
- Hyperechoic foci and strands
- Dilation of the main pancreatic duct
- Hyperechoic margins of the main pancreatic duct
Pancreatic function tests:
(a) Direct tests:
- Used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiologic findings
- Secretin stimulation test is considered the gold standard functional test for diagnosis of chronic pancreatitis. The observation that bi-carbonate production is impaired early in chronic pancreatitis has led to the rationale of use of this test in early stages of disease.
(b) Indirect tests:
- Used to assess the complications of chronic pancreatitis
- Not sensitive to assess pancreatic insufficiency in the early course of disease
References
- ↑ Bozkurt T, Braun U, Leferink S, Gilly G, Lux G (1994). "Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis". Gut. 35 (8): 1132–6. PMC 1375069. PMID 7523260.
- ↑ Axon AT, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR (1984). "Pancreatography in chronic pancreatitis: international definitions". Gut. 25 (10): 1107–12. PMC 1432537. PMID 6479687.
- ↑ Zuccaro G, Sivak MV (1992). "Endoscopic ultrasonography in the diagnosis of chronic pancreatitis". Endoscopy. 24 Suppl 1: 347–9. PMID 1633779.
- ↑ Catalano MF, Lahoti S, Geenen JE, Hogan WJ (1998). "Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis". Gastrointest. Endosc. 48 (1): 11–7. PMID 9684658.
- ↑ Wallace MB, Hawes RH, Durkalski V, Chak A, Mallery S, Catalano MF, Wiersema MJ, Bhutani MS, Ciaccia D, Kochman ML, Gress FG, Van Velse A, Hoffman BJ (2001). "The reliability of EUS for the diagnosis of chronic pancreatitis: interobserver agreement among experienced endosonographers". Gastrointest. Endosc. 53 (3): 294–9. PMID 11231386.
- ↑ Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P (2002). "EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study". Gastrointest. Endosc. 55 (4): 507–11. PMID 11923762.
- ↑ 7.0 7.1 Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, Najarian R, Tewani S, Dasilva D, Freedman S, Sheth S (2013). "Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis". Am. J. Gastroenterol. 108 (8): 1360–6. doi:10.1038/ajg.2013.148. PMC 5388854. PMID 23711627.