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Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings
Riccardo Negrelli1, Riccardo Manfredi, Beatrice Pedrinolla
1Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy, ricky.negrelli@gmail.com.
Aim:
To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis.
Methods:
MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement.
Results:
Signal intensity abnormalities were localized in the head in 10/26 (38.5%) and in the body-tail in 16/26 (61.5%) patients. MRCP showed a single MPD stenosis in 12/26 (46.1%) and multiple MPD stenosis in 14/26 (53.8%) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6%) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2%) patients with contrast retention.
Conclusions:
MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma.
Key Points:
• MRI represents the gold standard in the diagnosis of AIP. • MRCP is an increasingly useful technique in the diagnosis of focal AIP. • MRCP could be a problem-solving tool in the differential diagnosis of AIP.
Insights
Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) effectively diagnose focal autoimmune pancreatitis (AIP). Findings like multiple, long main pancreatic duct stenoses without upstream dilation suggest AIP and aid in differentiating it from pancreatic cancer.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Autoimmune pancreatitis (AIP) is a chronic inflammatory condition requiring accurate diagnosis.
- Focal AIP presents diagnostic challenges, often mimicking pancreatic malignancy.
Purpose of the Study:
- To evaluate magnetic resonance (MR) imaging and MR cholangiopancreatography (MRCP) findings in focal autoimmune pancreatitis (AIP).
- To describe the characteristic ductal involvement at diagnosis for focal AIP.
Main Methods:
- Retrospective analysis of MR examinations from 123 patients with AIP.
- Inclusion of 26 patients meeting International Consensus Diagnostic Criteria for focal AIP.
- Detailed assessment of pancreatic ductal and parenchymal features on MRCP and MRI.
Main Results:
- Abnormal signal intensity in the pancreatic head (38.5%) and body-tail (61.5%).
- MRCP revealed single (46.1%) or multiple (53.8%) main pancreatic duct stenoses without upstream dilation.
- Affected parenchyma showed hypointensity on T1, hyperintensity on T2, and hypovascularity during the arterial phase with contrast retention.
Conclusions:
- MR imaging and MRCP are effective for diagnosing AIP, demonstrating loss of lobulation and characteristic contrast enhancement.
- Multiple, long main pancreatic duct stenoses without upstream dilation on MRCP are suggestive of AIP.
- MRCP serves as a valuable tool in the differential diagnosis of AIP, particularly distinguishing it from pancreatic adenocarcinoma.
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