Abstract
This chapter outlines aspects of pancreatic imaging for type 1 autoimmune pancreatitis (AIP). AIP is subclassified as either type 1 (IgG4-related) or type 2 (granulocytic epithelial lesions) according to the International Consensus of Diagnostic Criteria for Autoimmune Pancreatitis. The imaging modalities reviewed are ultrasound (US), computed tomography (CT), and magnetic resonance (MR). Indications for endoscopic retrograde pancreatography (ERP) are also discussed in the context of the imaging findings.
When diffuse, sausage-like swelling of the pancreas is demonstrated on US, CT, or MRI, ERP is generally unnecessary. Conversely, when only localized swelling is detected on imaging, ERP is essential to exclude pancreatic cancer. The US findings in the pancreatic parenchyma characteristic of AIP are a hypoechoic area with scattered hyperechoic spots within the region of swelling. Contrast-enhanced CT and MRI demonstrate delayed enhancement and a capsule-like rim around the pancreas in AIP.
ERP and magnetic resonance pancreatography (MRP) can reveal irregular narrowings within the main pancreatic duct. These irregular narrowings can be either localized or distributed diffusely within the duct. Side branches arising from narrowed portions of the main pancreatic duct and (noncontinuous) multiple main pancreatic duct (skip lesions) are useful findings in the differentiation from pancreatic cancer. MRP cannot yet characterize irregular narrowing in the main pancreatic duct with sufficient accuracy to exclude pancreatic cancer, but skip lesions are useful to support the diagnosis. ERP is still required to distinguish these lesions in many clinical settings.
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References
Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8.
Stone JH, Khosroshahi A, Deshpande V, et al. Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations. Arthritis Rheum. 2012;64(10):3061–7.
Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the international association of pancreatology. Pancreas. 2011;40:352–8.
Sugumar A, Klöppel G, Chari ST. Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol. 2009;104:2308–10.
Okazaki K, Kawa S, Kamisawa T, et al. Japanese clinical guidelines for autoimmune pancreatitis. Pancreas. 2009;38(8):849–66.
Kawaguchi K, Koike M, Tsuruta K, et al. Lymphoplasmacytic sclerosing pancreatitis with cholangitis: a variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol. 1991;22(4):387–95.
Notohara K, Burgart LJ, Yadav D, et al. Idiopathic chronic pancreatitis with periductal lymphoplasmacytic infiltration: clinicopathologic features of 35 cases. Am J Surg Pathol. 2003;27(8):1119–27.
Zamboni G, Lüttges J, Capelli P, et al. Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch. 2004;445(6):552–63.
The Japanese Pancreas Society the Ministry of Health and Welfare Investigation Research Team for Intractable Pancreatic Disease: clinical diagnostic criteria for autoimmune pancreatitis 2011 (proposal). Suizo.2012;27:17–25
Okazaki K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41(7):626–31.
The Research Committee of Intractable Diseases of the Pancreas supported by the Japanese Ministry of Health, Labour and Welfare. Atlas of autoimmune pancreatitis (in Japanese): Arcmedium; 2007:1–54
Haaga JR, Alfidi RJ, Zelch MG, et al. Computed tomography of the pancreas. Radiology. 1976;120(3):589–95.
Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25(7):756–9.
Yoshizaki H, Takeuchi K, Okuda K, et al. Abdominal ultrasonogram of autoimmune pancreatitis: five cases of pancreatic lesions accompanied by Sjogren syndrome. J Med Ultrason. 1999;26:1125–36.
Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol. 1998;170(5):1323–7.
Sahani DV, Kalva SP, Farrell J, et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233(2):345–52.
Nakamoto Y, Sakahara H, Higashi T, et al. Autoimmune pancreatitis with F-18 fluoro-2-deoxy-D-glucose PET findings. Clin Nucl Med. 1999;24(10):778–80.
Saegusa H, Momose M, Kawa S, et al. Hilar and pancreatic gallium-67 accumulation is characteristic feature of autoimmune pancreatitis. Pancreas. 2003;27(1):20–5.
Toki F, Kozu T, Oi I. An unusual type of chronic pancreatitis showing diffuse narrowing of the entire main pancreatic duct on ERCP. A report of four cases. (abstract). Endoscopy. 1992;24:640.
Wakabayashi T, Kawaura Y, Satomura Y, et al. Clinical and imaging features of autoimmune pancreatitis with focal pancreatic swelling or mass formation: comparison with so-called tumor-forming pancreatitis and pancreatic carcinoma. Am J Gastroenterol. 2003;98:2679–87.
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Okazaki, K. (2014). Autoimmune Pancreatitis. In: Umehara, H., Okazaki, K., Stone, J., Kawa, S., Kawano, M. (eds) IgG4-Related Disease. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54228-5_10
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DOI: https://doi.org/10.1007/978-4-431-54228-5_10
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