Chronic Pancreatitis by Zhao-Shen Li Zhuan Liao Jian-Min Chen & Claude Férec

Author:Zhao-Shen Li, Zhuan Liao, Jian-Min Chen & Claude Férec
Language: eng
Format: epub
Publisher: Springer Singapore, Singapore

4.6.3 MRCP

In early stage CP, the ducts and more specifically the side branches are first involved. These changes correspond to the distribution of fibrosis that primarily involves the base of the side branch that will appear narrowed with a clubbed appearance. These changes are better detected by MRCP after secretin administration. In advanced stages of the disease, the diagnosis is easily established at MRCP by identifying structural changes involving both the MPD and the side branches, such as dilatation, narrowing or stricture formation, irregular contour, and filling defects (Fig. 7.10a, b). These changes are better detected by MRCP. The major limitation of MRCP concerns the detection of calcifications. Calcifications are seen as hypo intense filling defects surrounded by a bright fluid. When calcifications are grouped or scattered throughout the pancreas, the bright signal of the ducts is dramatically decreased, which may preclude their detection and makes unenhanced CT mandatory. Uniform dilatation of the main pancreatic duct and relative sparing or only mild dilatation of side branches are typical features of the obstructive type (secondary to a tumor) of CP in the advanced stage. In chronic calcifying pancreatitis , the side branches are also involved and MPD dilatation may be diffuse or focal as a consequence of the extent of surrounding fibrosis. The associated complications such as pseudocysts and bile duct strictures are also detected by MRCP (Fig. 7.11c).

Fig. 7.11Chronic pancreatitis on MRI. A 52-year-old male with history of recurrent severe epigastric pain. Axial T1-weighted fat-saturated spoiled gradient echo image (a) and Coronal MRCP (b) demonstrate a dilatation of the main pancreatic duct, side-branch ectasia, and filling defects in the head of the pancreas (arrow). A 45-year-old male with chronic pancreatitis Coronal MRCP (c) shows severe strictures of the main duct with pseudocyst formation in the head (arrow)

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