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Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP

G Carbognin1, V Girardi, C Biasiutti

  • 1Department of Radiology, University of Verona, P.le Scuro 10, 37134, Verona, Italy.

La Radiologia Medica
|October 1, 2009
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) reveal delayed enhancement and main pancreatic duct narrowing in autoimmune pancreatitis (AIP). Secretin-enhanced MRCP aids in differentiating focal AIP from pancreatic cancer.

Area of Science:

  • Radiology
  • Gastroenterology
  • Medical Imaging

Background:

  • Autoimmune pancreatitis (AIP) is a chronic inflammatory condition requiring accurate diagnosis.
  • Distinguishing AIP from other pancreatic diseases, particularly pancreatic cancer, is crucial for appropriate management.

Purpose of the Study:

  • To retrospectively analyze magnetic resonance (MR), MR cholangiopancreatography (MRCP), and secretin-enhanced MRCP findings in patients diagnosed with AIP.
  • To evaluate the utility of these imaging techniques in characterizing AIP and aiding differential diagnosis.

Main Methods:

  • Retrospective review of MR and MRCP examinations in 28 histopathologically confirmed AIP patients.
  • Secretin-enhanced MRCP was performed in 14 cases to assess pancreatic ductal dynamics.
  • Evaluation of pancreatic parenchymal changes, ductal morphology, and enhancement patterns.

Main Results:

  • MR imaging demonstrated pancreatic enlargement (focal in 57%, diffuse in 29%) and altered signal intensity (focal in 71%, diffuse in 29%).
  • Delayed pancreatic enhancement was universal in AIP, with peripheral rim enhancement in 29%.
  • MRCP revealed main pancreatic duct (MPD) narrowing in 61% and distal common bile duct narrowing in 43% of cases. Secretin-MRCP identified the 'duct-penetrating sign' in 43% of cases.

Conclusions:

  • Delayed enhancement and MPD stenosis on MR and MRCP are characteristic findings suggestive of AIP.
  • Secretin-enhanced MRCP serves as a valuable tool for differentiating focal AIP from ductal adenocarcinoma.

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