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Acute interstitial edematous pancreatitis: Findings on non-enhanced MR imaging
Xiao-Ming Zhang1, Zhi-Song Feng, Qiong-Hui Zhao
1Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan Province, China. zhangxm@nsmc.edu.cn
Aim:
To study the appearances of acute interstitial edematous pancreatitis (IEP) on non-enhanced MR imaging.
Methods:
A total of 53 patients with IEP diagnosed by clinical features and laboratory findings were underwent MR imaging. MR imaging sequences included fast spoiled gradient echo (FSPGR) fat saturation axial T1-weighted imaging, gradient echo T1-weighted (in phase), single shot fast spin echo (SSFSE) T2-weighted, respiratory triggered (R-T) T2-weighted with fat saturation, and MR cholangiopancreatography. Using the MR severity score index, pancreatitis was graded as mild (0-2 points), moderate (3-6 points) and severe (7-10 points).
Results:
Among the 53 patients, IEP was graded as mild in 37 patients and as moderate in 16 patients. Forty-seven of 53 (89%) patients had at least one abnormality on MR images. Pancreas was hypointense relative to liver on FSPGR T1-weighted images in 18.9% of patients, and hyperintense in 25% and 30% on SSFSE T2-weighted and R-T T2-weighted images, respectively. The prevalences of the findings of IEP on R-T T2-weighted images were, respectively, 85% for pancreatic fascial plane, 77% for left renal fascial plane, 55% for peripancreatic fat stranding, 42% for right renal fascial plane, 45% for perivascular fluid, 40% for thickened pancreatic lobular septum and 25% for peripancreatic fluid, which were markedly higher than those on in-phase or SSFSE T2-weighted images (P<0.001).
Conclusion:
IEP primarily manifests on non-enhanced MR images as thickened pancreatic fascial plane, left renal fascial plane, peripancreatic fat stranding, and peripancreatic fluid. R-T T2-weighted imaging is more sensitive than in-phase and SSFSE T2-weighted imaging for depicting IEP.
Insights
Non-enhanced MRI reveals acute interstitial edematous pancreatitis (IEP) through specific findings like thickened fascial planes and fat stranding. Respiratory-triggered T2-weighted imaging is superior for detecting these abnormalities in IEP patients.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Acute interstitial edematous pancreatitis (IEP) is a common form of pancreatitis.
- Accurate imaging is crucial for diagnosing and grading IEP.
- Non-enhanced Magnetic Resonance (MR) imaging offers a radiation-free approach to visualize pancreatic inflammation.
Purpose of the Study:
- To characterize the imaging appearances of acute interstitial edematous pancreatitis (IEP) using non-enhanced MR imaging.
- To evaluate the sensitivity of different non-enhanced MR sequences in depicting IEP findings.
Main Methods:
- Fifty-three patients with clinically and laboratorially diagnosed IEP underwent non-enhanced MR imaging.
- Imaging protocols included various T1-weighted, T2-weighted (including SSFSE and R-T fat-saturated), and MRCP sequences.
- Pancreatitis severity was graded using the MR severity score index (mild, moderate, severe).
Main Results:
- Eighty-nine percent of patients showed at least one MR abnormality.
- Key findings included thickened pancreatic fascial plane (85%), left renal fascial plane (77%), and peripancreatic fat stranding (55%) on R-T T2-weighted images.
- Respiratory-triggered T2-weighted imaging demonstrated significantly higher prevalence of IEP findings compared to in-phase and SSFSE T2-weighted images (P<0.001).
Conclusions:
- Non-enhanced MR imaging effectively visualizes IEP, with characteristic findings on fascial planes and peripancreatic fat.
- Respiratory-triggered T2-weighted imaging is more sensitive for detecting IEP manifestations than other non-enhanced T2-weighted sequences.
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