Imaging

Chronic Pancreatitis

Preliminary Diagnosis: Chronic Pancreatitis

I. What imaging technique is first-line for this diagnosis?

  • CT of the abdomen and pelvis with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of chronic pancreatitis.

Advantages

  • Quick

  • Inexpensive

  • Specific for diagnosis

  • Can detect associated findings with chronic pancreatitis, including masses, pseudocyts, and others

Disadvantages

  • May be difficult to see imaging findings of chronic pancreatitis without administration of intravenous contrast.

III. What are the contraindications for the first-line imaging technique?

Relative contraindication includes pregnancy

IV. What alternative imaging techniques are available?

  • MRI with and without contrast

  • Magnetic resonance cholangiopancreatography (MRCP)

  • Ultrasonography

  • Plain radiographs

  • Endoscopic retrograde cholangiopancreatography (ERCP)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of chronic pancreatitis.

MRI with and without contrast

Advantages

  • Diagnostic

  • Can accurately detect associated findings

  • Does not require the use of ionizing radiation

Disadvantages

  • Time consuming

  • Expensive

  • Requires significant patient cooperation to minimize motion artifact

MRCP

Advantages

  • Can often see well-depicted fluid-containing structures

  • Can offer significant detail of bilary tract

  • Does not require the use of ionizing radiation

Disadvantages

  • Time consuming

  • Expensive

  • Requires significant patient cooperation to minimize motion artifact

Ultrasonography

Advantages

  • Inexpensive

  • Can detect dilated common bile duct and a dilated major pancreatic duct

  • Does not require the use of ionizing radiation

Disadvantages

  • Often difficult to appreciate abnormalities of the pancreas and associated vessels and soft tissue structures

Plain radiographs

Advantages

  • Inexpensive

  • Quick

  • Portable

Disadvantages

  • Lacks sensitivity or specificity for diagnosis

  • Usually requires abundant pancreatic calcifications for meaningful diagnosis

ERCP

Advantages

  • Can perform therapeutic manuevers if appropriate

  • Can perform additional diagnostic maneuvers including biopsy

Disadvantages

  • Exposure to ionizing radiation

  • Time consuming

  • Operator dependent

  • Invasive

VI. What are the contraindications for the alternative imaging techniques?

MRI with and without contrast

Absolute contraindication is non-MR-compatible hardware devices

MRCP

Absolute contraindication is non-MR-compatible hardware devices

Ultrasonography

No significant contraindications

Plain radiographs

May require consent in pregnant patients at some institutions

ERCP

Relative contraindication includes pregnancy

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