Vanishing pancreas: CT and MRI features and imaging diagnostic strategies

The vanishing pancreas is a frequently overlooked condition which can result from partial or complete dorsal pancreatic agenesis, intra-pancreatic fat deposition (IPFD) and pancreatic atrophy caused by chronic pancreatitis. A variety of diseases, including cystic fibrosis, maturity-onset diabetes of the young type 8, Shwachman-Diamond syndrome, and Johanson-Blizzard syndrome, can manifest as IPFD. Dorsal pancreatic agenesis can, albeit rarely, coexist with abnormalities or tumors. This review aimed to summarize the various causes that may result in partial or complete vanishing pancreas on computed tomography/magnetic resonance imaging (CT/MRI). We provide a comprehensive review of these imaging findings and their corresponding clinical characteristics, which are crucial for ensuring an accurate diagnosis. CRITICAL RELEVANCE STATEMENT: By reviewing various causes of pancreatic vanishing, we summarize these imaging findings and their corresponding clinical characteristics, which is crucial for ensuring an accurate diagnosis and patient management. KEY POINTS: Imaging findings of partial or complete pancreatic vanishing reveal a hypodense pancreas (resembling fat density) or visibility of only the pancreatic head and proximal body. Pancreatic vanishing can result from dorsal pancreatic agenesis, intra-pancreatic fat deposition, and atrophy caused by chronic pancreatitis. Intra-pancreatic fat deposition is associated with genetic and systemic diseases.