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Pancreatitis in patients with pancreas divisum: imaging features at MRI and MRCP
Deng-Bin Wang1, Jinxing Yu, Ann S Fulcher
1Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China. dbwang8@aliyun.com
Aim:
To determine the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) features of pancreatitis with pancreas divisum (PD) and the differences vs pancreatitis without divisum.
Methods:
Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study. During one year period, 1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner. Two experienced radiologists retrospectively reviewed all the studies in consensus. Disputes were resolved via consultation with a third experienced radiologist. The assessment included presence and the imaging findings of PD, pancreatitis, and distribution of abnormalities. The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group. MRCP and MRI findings were correlated with final diagnosis. Fisher exact tests and Pearson × 2 tests were performed.
Results:
Pancreatitis was demonstrated at MRCP and MRI in 173 cases (38 cases with and 135 cases without divisum) among the 1439 consecutive cases. The recurrent acute pancreatitis accounted for 55.26% (21 of 38) in pancreatitis patients associated with PD, which was higher than 6.67% (9 of 135) in the control group, whereas the chronic pancreatitis was a dominant type in the control group (85.19%, 115 of 135) when compared to the study group (42.11%, 16 of 38) (χ(2) = 40.494, P < 0.0001). In cases of pancreatitis with PD, the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD (17 of 38, 44.74% vs 30 of 135, 22.22%) (χ(2) = 7.257, P < 0.05).
Conclusion:
MRCP and MRI can depict the features of pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum.
Insights
Pancreatitis with pancreas divisum (PD) often presents as recurrent acute episodes and dorsal inflammation, differing from chronic pancreatitis common in those without PD. MRCP and MRI effectively visualize these distinct features.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Pancreas divisum (PD) is a common congenital anomaly of the pancreaticobiliary system.
- Its association with pancreatitis, particularly the imaging features, requires further elucidation.
- Understanding these differences is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) findings in patients with pancreatitis and PD.
- To compare these imaging features with those of pancreatitis patients without PD.
Main Methods:
- A retrospective analysis of 1439 patients who underwent MRCP and abdominal MRI was conducted.
- Two experienced radiologists assessed imaging for PD, pancreatitis, and abnormality distribution.
- Statistical analysis, including Fisher exact and Pearson chi-squared tests, was used to compare groups.
Main Results:
- Of 173 patients with pancreatitis, 38 had PD. Recurrent acute pancreatitis was significantly higher in the PD group (55.26% vs. 6.67%).
- Chronic pancreatitis was more prevalent in the non-PD group (85.19% vs. 42.11%).
- Dorsal pancreatitis involvement was also more common in patients with PD (44.74% vs. 22.22%).
Conclusions:
- MRCP and MRI are effective in visualizing the characteristic features of pancreatitis associated with PD.
- Recurrent acute pancreatitis and isolated dorsal involvement are key imaging indicators of PD in pancreatitis patients.
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