Pain Imaging pp 247-274 | Cite as

Imaging of Pancreatitis

  • Roberto Pozzi Mucelli
  • Riccardo Negrelli
  • Matteo Catania
  • Marco Chincarini


Acute pancreatitis is an acute inflammatory process of the pancreatic gland that can involve pancreatic parenchyma or distant organs. The incorporation of the revised Atlanta classification system into everyday practice would provide the use of a standardized terminology and the chance to correctly classify and recognize every imaging finding of acute pancreatitis. It refers to diagnostic criteria, clinical classification—both phases (early and late) and severity (mild, moderately severe, and severe) of acute pancreatitis—morphological classification (interstitial edematous pancreatitis and necrotizing pancreatitis), and complications (organ failure, systemic and local complications). In the revised Atlanta classification, the most important local complications are the pancreatic and peripancreatic collection, and they may be sterile or infected; we should distinguish various types of collections: acute peripancreatic fluid collection (APFC), pseudocyst, acute necrotic collection (ANC), and walled-off necrosis (WON). The parameters for this classification are the time course (<4 weeks or >4 weeks) and the presence of necrosis. Chronic pancreatitis (CP) is an inflammatory disease characterized by progressive and irreversible distortion and destruction of the pancreatic parenchyma, with progressive loss of the endocrine and exocrine function of the gland. The clinical diagnosis of chronic pancreatitis is usually achieved only in advanced disease. The etiology and the pathophysiology of chronic pancreatitis are not well defined. The TIGAR-O risk factor system lists factors associated with chronic pancreatitis. Imaging modalities in the evaluation of CP typically include enhanced computed tomography (CT), MRI with magnetic resonance cholangiopancreatography (MRCP), and ultrasound with a transabdominal or endoscopic approach. The morphological classification of chronic pancreatitis divides CP in macro- and micro-obstructive forms. In the early stages of chronic pancreatitis, pancreatic alterations are usually unspecific and inconclusive. In advanced disease, parenchymal and ductal alterations are irreversible and can be limited to the secondary ducts (small-duct form) or might extend to the main pancreatic duct (large-duct form). The consequence of the obstruction of the pancreatic ductal system is the precipitation of dense protein plugs within the ducts, which gradually calcify in small or large calcifications. Other forms of CP include paraduodenal pancreatitis, autoimmune pancreatitis, and hereditary chronic pancreatitis.


Acute pancreatitis Chronic pancreatitis Paraduodenal pancreatitis Autoimmune pancreatitis Ultrasound Computed tomography Magnetic resonance imaging 

Supplementary material

Video 14.1a

Interstitial edematous pancreatitis (IEP). Axial CT non-contrast phase (a) shows a normal pancreatic parenchyma. (MOV 64367 kb)

Video 14.1b

Interstitial edematous pancreatitis (IEP). Axial CT arterial phase (b) show a pancreatic parenchyma with normal enhancement. Mild inflammatory changes (stranding of the peripancreatic fat tissues) are visible. (MOV 65575 kb)

Video 14.1c

Interstitial edematous pancreatitis (IEP). Portal-venous phase (c) show a pancreatic parenchyma with normal enhancement. Mild inflammatory changes (stranding of the peripancreatic fat tissues) are visible. (MOV 99033 kb)

Video 14.2a

Combined pancreatic and peripancreatic necrosis. Axial CT non-contrast phase images (a) show a highly inhomogeneous pancreatic parenchyma of the head which results hypovascular during the pancreatic and portal-venous phases (b), with multiple hypodense areas due to necrosis that extend to the peripancreatic tissues. (MOV 90000 kb)

Video 14.2b

Combined pancreatic and peripancreatic necrosis. Axial CT non-contrast phase images (a) show a highly inhomogeneous pancreatic parenchyma of the head which results hypovascular during the pancreatic and portal-venous phases (b), with multiple hypodense areas due to necrosis that extend to the peripancreatic tissues. (MOV 244785 kb)

Video 14.3a

Pancreatic pseudocyst. Axial CT non-contrast phase (a) shows a large, hypodense and homogeneous fluid collection in the body-tail of the pancreas, 4 weeks after the first episode of acute pancreatitis. (MOV 79785 kb)

Video 14.3b

Pancreatic pseudocyst. Axial arterial-pancreatic phase (b) better show that the fluid collection is encapsulated, with no solid components. (MOV 76150 kb)

Video 14.3c

Pancreatic pseudocyst. Portal-venous phase (c) better show that the fluid collection is encapsulated, with no solid components. (MOV 142098 kb)

Video 14.3d

Pancreatic pseudocyst. In the MRI coronal T2-weighted sequence (d), the pseudocyst appears homogeneously hyperintense and well circumscribed. (MOV 10205 kb)

Video 14.4

WON. Axial CT arterial, portal-venous and delayed phase show a heterogeneous collection with fluid components, non-liquefied debris and fat globules inside. The collection has thick enhancing walls and is by definition a WON. Furthermore this images show the presence of large amount of intraperitoneal fluid. (MOV 117617 kb)

Video 14.5a

Infected collection. Axial non-contrast (a) CT images obtained 6 weeks after onset of acute necrotizing pancreatitis, show the presence of multiple air bubbles within the heterogeneous necrotic collection. (MOV 73041 kb)

Video 14.5b

Infected collection. The infected WON extends to the left lateroconal fascia. The thick wall of the necrotic collection are better depicted during the pancreatic phase (b). The patient has also bilateral pleural effusion. (MOV 63658 kb)

Video 14.5c

Infected collection. The infected WON extends to the left lateroconal fascia. The thick wall of the necrotic collection are better depicted during the portal-venous phase (c). The patient has also bilateral pleural effusion. (MOV 68475 kb)

Video 14.6a

Axial non-contrast (a) CT images obtained 5 weeks after onset of acute pancreatitis, show the presence of multiple calcifications of the pancreatic head. (MOV 30716 kb)

Video 14.6b

Axial portal-venous phase (b), shows the presence of an infected necrotic collection within the splenic parenchyma (notice the presence of multiple air bubbles) an multiple necrotic collections (WON) localized in the peripancreatic fat of the body-tail of the gland. One of these infected collections communicates with the anterior abdominal wall. (MOV 30984 kb)

Video 14.7a

Assessment of the composition of a pancreatic fluid collection. Axial CT images on portal-venous phase (a) show an inhomogeneous pancreatic fluid collection involving the entire pancreatic gland. (MOV 8962 kb)

Video 14.7b

MRI coronal T2-weighted image (b) better demonstrates the presence of non-liquefied material suggestive for necrotic debris and permits an accurate diagnosis of WON. Notice the presence of a homogeneous fluid collection localized in the right lateroconal fascia, with no solid components, suggestive for pseudocyst. (MOV 37460 kb)

Video 14.8a

Chronic pancreatitis. Axial CT images acquired during the pancreatic phase (a) show multiple calcifications of the pancreatic head with marked dilation of the upstream main pancreatic duct which shows a tortuous path. (MOV 21200 kb)

Video 14.8b

Chronic pancreatitis. Axial CT images acquired during the portal-venous phase (b) show multiple calcifications of the pancreatic head with marked dilation of the upstream main pancreatic duct which shows a tortuous path. (MOV 44994 kb)

Video 14.9a

Chronic pancreatitis. Axial CT images acquired during the pancreatic phase (a) show multiple calcifications within the pancreatic ductal system of the head of the pancreas and a large calcification of the main pancreatic duct in the pancreatic body. The MPD is diffusely dilated, with air within the lumen. (MOV 24890 kb)

Video 14.9b

Chronic pancreatitis. Axial CT images acquired during the portal-venous phase (b) show multiple calcifications within the pancreatic ductal system of the head of the pancreas and a large calcification of the main pancreatic duct in the pancreatic body. The MPD is diffusely dilated, with air within the lumen. (MOV 47476 kb)

Video 14.10a

Chronic pancreatitis. Axial fat-suppressed T1-weighted images (a) show an atrophic pancreatic parenchyma, which appears hypointense as compared to the liver parenchyma. (MOV 2578 kb)

Video 14.10b

Chronic pancreatitis. Axial T2-weighted images (b) show an irregular dilation of the main pancreatic duct. (MOV 3650 kb)

Video 14.10c

Chronic pancreatitis. After contrast medium injection, the pancreatic parenchyma appears hypovascular during the pancreatic phase (c), with progressive delayed enhancement during the portal-venous and delayed phases (d, e). (MOV 16179 kb)

Video 14.10d

Chronic pancreatitis. After contrast medium injection, the pancreatic parenchyma appears hypovascular during the pancreatic phase (c), with progressive delayed enhancement during the portal-venous and delayed phases (d, e). (MOV 15418 kb)

Video 14.10e

Chronic pancreatitis. After contrast medium injection, the pancreatic parenchyma appears hypovascular during the pancreatic phase (c), with progressive delayed enhancement during the portal-venous and delayed phases (d, e). (MOV 15561 kb)


  1. 1.
    Bradley EL, 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586–90.Google Scholar
  2. 2.
    Bollen TL, van Santvoort HC, Besselink MG, van Es WH, Gooszen HG, van Leeuwen MS. Update on acute pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR. 2007;28(5):371–83.Google Scholar
  3. 3.
    Merkle EM, Gorich J. Imaging of acute pancreatitis. Eur Radiol. 2002;12(8):1979–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta classification for acute pancreatitis: a pictorial essay. Radiographics. 2016;36(3):675–87.PubMedCrossRefGoogle Scholar
  5. 5.
    Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371(9607):143–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Zhao K, Adam SZ, Keswani RN, Horowitz JM, Miller FH. Acute pancreatitis: revised Atlanta classification and the role of cross-sectional imaging. AJR Am J Roentgenol. 2015;205(1):W32–41.PubMedCrossRefGoogle Scholar
  7. 7.
    Forsmark CE, Baillie J. AGA Institute technical review on acute pancreatitis. Rev Gastroenterol Mex. 2007;72(3):257–85.PubMedGoogle Scholar
  8. 8.
    Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. 2006;354(20):2142–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunnick NR, Langlotz CP. The radiology report of the future: a summary of the 2007 intersociety conference. J Am Coll Radiol. 2008;5(5):626–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Ellenbogen PH. BI-RADS: revised and replicated. J Am Coll Radiol. 2014;11(1):2.PubMedCrossRefGoogle Scholar
  11. 11.
    Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet. 2011;377(9772):1184–97.PubMedCrossRefGoogle Scholar
  12. 12.
    Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001;120(3):682–707.PubMedCrossRefGoogle Scholar
  13. 13.
    Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas”, “para-duodenal wall cyst”, and “groove pancreatitis”. Semin Diagn Pathol. 2004;21(4):247–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Levy P, Dominguez-Munoz E, Imrie C, Lohr M, Maisonneuve P. Epidemiology of chronic pancreatitis: burden of the disease and consequences. United Eur Gastroenterol J. 2014;2(5):345–54.CrossRefGoogle Scholar
  15. 15.
    Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–61.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Majumder S, Chari ST. Chronic pancreatitis. Lancet. 2016;387(10031):1957–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16(2):218–24.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Graziani R, Frulloni L, Cicero C, Manfredi R, Ambrosetti MC, Mautone S, et al. Bull’s-eye pattern of pancreatic-duct stones on multidetector computed tomography and gene-mutation-associated pancreatitis (GMAP). Radiol Med. 2012;117(8):1275–86.PubMedCrossRefGoogle Scholar
  19. 19.
    Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015;149(6):1490–500. e1.PubMedCrossRefGoogle Scholar
  20. 20.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Baker ME, Nelson RC, Rosen MP, Blake MA, Cash BD, Hindman NM, et al. ACR Appropriateness Criteria(R) acute pancreatitis. Ultrasound Q. 2014;30(4):267–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Singh VK, Bollen TL, Wu BU, Repas K, Maurer R, Yu S, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. 2011;9(12):1098–103.PubMedCrossRefGoogle Scholar
  23. 23.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.PubMedCrossRefGoogle Scholar
  24. 24.
    Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012;262(3):751–64.PubMedCrossRefGoogle Scholar
  25. 25.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990;174(2):331–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. 2004;183(5):1261–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Trout AT, Elsayes KM, Ellis JH, Francis IR. Imaging of acute pancreatitis: prognostic value of computed tomographic findings. J Comput Assist Tomogr. 2010;34(4):485–95.PubMedCrossRefGoogle Scholar
  28. 28.
    Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.PubMedCrossRefGoogle Scholar
  29. 29.
    Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. AJR Am J Roentgenol. 2008;190(3):643–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Pelaez-Luna M, Vege SS, Petersen BT, Chari ST, Clain JE, Levy MJ, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc. 2008;68(1):91–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Tuney D, Altun E, Barlas A, Yegen C. Pancreatico-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water soluble contrast media. Jop. 2008;9(1):26–9.PubMedGoogle Scholar
  32. 32.
    Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF. Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR. 2008;29(5):322–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Bernades P, Baetz A, Levy P, Belghiti J, Menu Y, Fekete F. Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients. Dig Dis Sci. 1992;37(3):340–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Mortele KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, et al. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol. 2004;52(1):67–72.PubMedCrossRefGoogle Scholar
  35. 35.
    Bharwani N, Patel S, Prabhudesai S, Fotheringham T, Power N. Acute pancreatitis: the role of imaging in diagnosis and management. Clin Radiol. 2011;66(2):164–75.PubMedCrossRefGoogle Scholar
  36. 36.
    Mallick IH, Winslet MC. Vascular complications of pancreatitis. Jop. 2004;5(5):328–37.PubMedGoogle Scholar
  37. 37.
    Hirota M, Kimura Y, Ishiko T, Beppu T, Yamashita Y, Ogawa M. Visualization of the heterogeneous internal structure of so-called “pancreatic necrosis” by magnetic resonance imaging in acute necrotizing pancreatitis. Pancreas. 2002;25(1):63–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Busireddy KK, AlObaidy M, Ramalho M, Kalubowila J, Baodong L, Santagostino I, et al. Pancreatitis-imaging approach. World J Gastrointest Pathophysiol. 2014;5(3):252–70.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Werner J, Feuerbach S, Uhl W, Buchler MW. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005;54(3):426–36.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25(7):756–9.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994;107(5):1481–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Tirkes T, Sandrasegaran K, Sanyal R, Sherman S, Schmidt CM, Cote GA, et al. Secretin-enhanced MR cholangiopancreatography: spectrum of findings. Radiographics. 2013;33(7):1889–906.PubMedCrossRefGoogle Scholar
  43. 43.
    Carbognin G, Pinali L, Girardi V, Casarin A, Mansueto G, Mucelli RP. Collateral branches IPMTs: secretin-enhanced MRCP. Abdom Imaging. 2007;32(3):374–80.PubMedCrossRefGoogle Scholar
  44. 44.
    Bian Y, Wang L, Chen C, Lu JP, Fan JB, Chen SY, et al. Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP. World J Gastroenterol. 2013;19(41):7177–82.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Balci C. MRI assessment of chronic pancreatitis. Diagn Interv Radiol. 2011;17(3):249–54.PubMedGoogle Scholar
  46. 46.
    Hamed MM, Hamm B, Ibrahim ME, Taupitz M, Mahfouz AE. Dynamic MR imaging of the abdomen with gadopentetate dimeglumine: normal enhancement patterns of the liver, spleen, stomach, and pancreas. AJR Am J Roentgenol. 1992;158(2):303–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Wallner BK, Schumacher KA, Weidenmaier W, Friedrich JM. Dilated biliary tract: evaluation with MR cholangiography with a T2-weighted contrast-enhanced fast sequence. Radiology. 1991;181(3):805–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Hansen TM, Nilsson M, Gram M, Frokjaer JB. Morphological and functional evaluation of chronic pancreatitis with magnetic resonance imaging. World J Gastroenterol. 2013;19(42):7241–6.Google Scholar
  49. 49.
    Takehara Y, Ichijo K, Tooyama N, Kodaira N, Yamamoto H, Tatami M, et al. Breath-hold MR cholangiopancreatography with a long-echo-train fast spin-echo sequence and a surface coil in chronic pancreatitis. Radiology. 1994;192(1):73–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Arish MA, Yucel EK, Soto JA, Chuttani R, Ferrucci JT. MR cholangiopancreatography: efficacy of three-dimensional turbo spin-echo technique. AJR Am J Roentgenol. 1995;165(2):295–300.CrossRefGoogle Scholar
  51. 51.
    Kim JH, Hong SS, Eun HW, Han JK, Choi BI. Clinical usefulness of free-breathing navigator-triggered 3D MRCP in non-cooperative patients: comparison with conventional breath-hold 2D MRCP. Eur J Radiol. 2012;81(4):e513–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Kamisawa T, Tu Y, Egawa N, Tsuruta K, Okamoto A, Kamata N. MRCP of congenital pancreaticobiliary malformation. Abdom Imaging. 2007;32(1):129–33.PubMedCrossRefGoogle Scholar
  53. 53.
    Boninsegna E, Manfredi R, Ventriglia A, Negrelli R, Pedrinolla B, Mehrabi S, et al. Santorinicele: secretin-enhanced magnetic resonance cholangiopancreatography findings before and after minor papilla sphincterotomy. Eur Radiol. 2015;25(8):2437–44.PubMedCrossRefGoogle Scholar
  54. 54.
    Boninsegna E, Manfredi R, Negrelli R, Avesani G, Mehrabi S, Pozzi Mucelli R. Pancreatic duct stenosis: differential diagnosis between malignant and benign conditions at secretin-enhanced MRCP. Clin Imaging. 2017;41:137–43.PubMedCrossRefGoogle Scholar
  55. 55.
    Cappeliez O, Delhaye M, Deviere J, Le Moine O, Metens T, Nicaise N, et al. Chronic pancreatitis: evaluation of pancreatic exocrine function with MR pancreatography after secretin stimulation. Radiology. 2000;215(2):358–64.PubMedCrossRefGoogle Scholar
  56. 56.
    Kahl S, Glasbrenner B, Leodolter A, Pross M, Schulz HU, Malfertheiner P. EUS in the diagnosis of early chronic pancreatitis: a prospective follow-up study. Gastrointest Endosc. 2002;55(4):507–11.PubMedCrossRefGoogle Scholar
  57. 57.
    Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010;42(Suppl 6):S381–406.PubMedCrossRefGoogle Scholar
  58. 58.
    Manfredi R, Brizi MG, Masselli G, Gui B, Vecchioli A, Marano P. Imaging of chronic pancreatitis. Rays. 2001;26(2):143–9.PubMedGoogle Scholar
  59. 59.
    Matos C, Deviere J, Cremer M, Nicaise N, Struyven J, Metens T. Acinar filling during secretin-stimulated MR pancreatography. AJR Am J Roentgenol. 1998;171(1):165–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Matos C, Metens T, Deviere J, Nicaise N, Braude P, Van Yperen G, et al. Pancreatic duct: morphologic and functional evaluation with dynamic MR pancreatography after secretin stimulation. Radiology. 1997;203(2):435–41.PubMedCrossRefGoogle Scholar
  61. 61.
    Manikkavasakar S, AlObaidy M, Busireddy KK, Ramalho M, Nilmini V, Alagiyawanna M, et al. Magnetic resonance imaging of pancreatitis: an update. World J Gastroenterol. 2014;20(40):14760–77.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Bollen TL. Imaging of acute pancreatitis: update of the revised Atlanta classification. Radiol Clin North Am. 2012;50(3):429–45.PubMedCrossRefGoogle Scholar
  63. 63.
    Winstead NS, Wilcox CM. Clinical trials of pancreatic enzyme replacement for painful chronic pancreatitis--a review. Pancreatology. 2009;9(4):344–50.PubMedCrossRefGoogle Scholar
  64. 64.
    Forsmark CE. Management of chronic pancreatitis. Gastroenterology. 2013;144(6):1282–91. e3.PubMedCrossRefGoogle Scholar
  65. 65.
    Dite P, Ruzicka M, Zboril V, Novotny I. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy. 2003;35(7):553–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Diener MK, Rahbari NN, Fischer L, Antes G, Buchler MW, Seiler CM. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg. 2008;247(6):950–61.PubMedCrossRefGoogle Scholar
  67. 67.
    Buchler MW, Warshaw AL. Resection versus drainage in treatment of chronic pancreatitis. Gastroenterology. 2008;134(5):1605–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Shanbhogue AK, Fasih N, Surabhi VR, Doherty GP, Shanbhogue DK, Sethi SK. A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics. 2009;29(4):1003–26.PubMedCrossRefGoogle Scholar
  69. 69.
    Triantopoulou C, Dervenis C, Giannakou N, Papailiou J, Prassopoulos P. Groove pancreatitis: a diagnostic challenge. Eur Radiol. 2009;19(7):1736–43.Google Scholar
  70. 70.
    Kim JD, Han YS, Choi DL. Characteristic clinical and pathologic features for preoperative diagnosed groove pancreatitis. J Korean Surg Soc. 2011;80(5):342–7.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Arora A, Rajesh S, Mukund A, Patidar Y, Thapar S, Arora A, et al. Clinicoradiological appraisal of ‘paraduodenal pancreatitis’: Pancreatitis outside the pancreas! Indian J Radiol Imaging. 2015;25(3):303–14.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Shudo R, Obara T, Tanno S, Fujii T, Nishino N, Sagawa M, et al. Segmental groove pancreatitis accompanied by protein plugs in Santorini’s duct. J Gastroenterol. 1998;33(2):289–94.PubMedCrossRefGoogle Scholar
  73. 73.
    Hartwig W, Werner J, Ryschich E, Mayer H, Schmidt J, Gebhard MM, et al. Cigarette smoke enhances ethanol-induced pancreatic injury. Pancreas. 2000;21(3):272–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Procacci C, Graziani R, Zamboni G, Cavallini G, Pederzoli P, Guarise A, et al. Cystic dystrophy of the duodenal wall: radiologic findings. Radiology. 1997;205(3):741–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Arora A, Dev A, Mukund A, Patidar Y, Bhatia V, Sarin SK. Paraduodenal pancreatitis. Clin Radiol. 2014;69(3):299–306.PubMedCrossRefGoogle Scholar
  76. 76.
    Kalb B, Martin DR, Sarmiento JM, Erickson SH, Gober D, Tapper EB, et al. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology. 2013;269(2):475–81.PubMedCrossRefGoogle Scholar
  77. 77.
    Casetti L, Bassi C, Salvia R, Butturini G, Graziani R, Falconi M, et al. “Paraduodenal” pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg. 2009;33(12):2664–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Shimosegawa T, Chari ST, Frulloni L, Kamisawa T, Kawa S, Mino-Kenudson M, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the international association of pancreatology. Pancreas. 2011;40(3):352–8.PubMedCrossRefGoogle Scholar
  79. 79.
    Chari ST, Kloeppel G, Zhang L, Notohara K, Lerch MM, Shimosegawa T. Histopathologic and clinical subtypes of autoimmune pancreatitis: the honolulu consensus document. Pancreatology. 2010;10(6):664–72.PubMedCrossRefGoogle Scholar
  80. 80.
    Kloppel G, Detlefsen S, Chari ST, Longnecker DS, Zamboni G. Autoimmune pancreatitis: the clinicopathological characteristics of the subtype with granulocytic epithelial lesions. J Gastroenterol. 2010;45(8):787–93.PubMedCrossRefGoogle Scholar
  81. 81.
    Kloppel G, Sipos B, Zamboni G, Kojima M, Morohoshi T. Autoimmune pancreatitis: histo- and immunopathological features. J Gastroenterol. 2007;42(Suppl 18):28–31.PubMedCrossRefGoogle Scholar
  82. 82.
    Zamboni G, Luttges J, Capelli P, Frulloni L, Cavallini G, Pederzoli 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.PubMedCrossRefGoogle Scholar
  83. 83.
    Frulloni L, Scattolini C, Falconi M, Zamboni G, Capelli P, Manfredi R, et al. Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol. 2009;104(9):2288–94.PubMedCrossRefGoogle Scholar
  84. 84.
    Frulloni L, Amodio A, Katsotourchi AM, Vantini I. A practical approach to the diagnosis of autoimmune pancreatitis. World J Gastroenterol. 2011;17(16):2076–9.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Manfredi R, Frulloni L, Mantovani W, Bonatti M, Graziani R, Pozzi Mucelli R. Autoimmune pancreatitis: pancreatic and extrapancreatic MR imaging-MR cholangiopancreatography findings at diagnosis, after steroid therapy, and at recurrence. Radiology. 2011;260(2):428–36.PubMedCrossRefGoogle Scholar
  86. 86.
    Manfredi R, Graziani R, Cicero C, Frulloni L, Carbognin G, Mantovani W, et al. Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology. 2008;247(2):435–43.PubMedCrossRefGoogle Scholar
  87. 87.
    Negrelli R, Manfredi R, Pedrinolla B, Boninsegna E, Ventriglia A, Mehrabi S, et al. Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol. 2015;25(2):359–67.PubMedCrossRefGoogle Scholar
  88. 88.
    Crosara S, D’Onofrio M, De Robertis R, Demozzi E, Canestrini S, Zamboni G, et al. Autoimmune pancreatitis: multimodality non-invasive imaging diagnosis. World J Gastroenterol. 2014;20(45):16881–90.PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Sugumar A, Levy MJ, Kamisawa T, Webster GJ, Kim MH, Enders F, et al. Endoscopic retrograde pancreatography criteria to diagnose autoimmune pancreatitis: an international multicentre study. Gut. 2011;60(5):666–70.PubMedCrossRefGoogle Scholar
  90. 90.
    Graziani R, Frulloni L, Mantovani W, Ambrosetti MC, Mautone S, Re TJ, et al. Autoimmune pancreatitis and non-necrotizing acute pancreatitis: computed tomography pattern. Dig Liver Dis. 2012;44(9):759–66.PubMedCrossRefGoogle Scholar
  91. 91.
    Graziani R, Mautone S, Ambrosetti MC, Manfredi R, Re TJ, Calculli L, et al. Autoimmune pancreatitis: multidetector-row computed tomography (MDCT) and magnetic resonance (MR) findings in the Italian experience. Radiol Med. 2014;119(8):558–71.PubMedCrossRefGoogle Scholar
  92. 92.
    Ikeura T, Detlefsen S, Zamboni G, Manfredi R, Negrelli R, Amodio A, et al. Retrospective comparison between preoperative diagnosis by international consensus diagnostic criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer. Pancreas. 2014;43(5):698–703.PubMedCrossRefGoogle Scholar
  93. 93.
    Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007;242(3):791–801.PubMedCrossRefGoogle Scholar
  94. 94.
    Kamisawa T, Chari ST, Giday SA, Kim MH, Chung JB, Lee KT, et al. Clinical profile of autoimmune pancreatitis and its histological subtypes: an international multicenter survey. Pancreas. 2011;40(6):809–14.PubMedCrossRefGoogle Scholar
  95. 95.
    Whitcomb DC, Gorry MC, Preston RA, Furey W, Sossenheimer MJ, Ulrich CD, et al. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet. 1996;14(2):141–5.PubMedCrossRefGoogle Scholar
  96. 96.
    Cohn JA, Mitchell RM, Jowell PS. The impact of cystic fibrosis and PSTI/SPINK1 gene mutations on susceptibility to chronic pancreatitis. Clin Lab Med. 2005;25(1):79–100.PubMedCrossRefGoogle Scholar
  97. 97.
    Durie PR. Pancreatitis and mutations of the cystic fibrosis gene. N Engl J Med. 1998;339(10):687–8.PubMedCrossRefGoogle Scholar
  98. 98.
    Chen JM, Mercier B, Audrezet MP, Ferec C. Mutational analysis of the human pancreatic secretory trypsin inhibitor (PSTI) gene in hereditary and sporadic chronic pancreatitis. J Med Genet. 2000;37(1):67–9.PubMedPubMedCentralCrossRefGoogle Scholar
  99. 99.
    Kume K, Masamune A, Mizutamari H, Kaneko K, Kikuta K, Satoh M, et al. Mutations in the serine protease inhibitor Kazal Type 1 (SPINK1) gene in Japanese patients with pancreatitis. Pancreatology. 2005;5(4–5):354–60.PubMedCrossRefGoogle Scholar
  100. 100.
    Rohrmann CA, Surawicz CM, Hutchinson D, Silverstein FE, White TT, Marchioro TL. The diagnosis of hereditary pancreatitis by pancreatography. Gastrointest Endosc. 1981;27(3):168–73.PubMedCrossRefGoogle Scholar
  101. 101.
    Hoshina K, Kimura W, Ishiguro T, Tominaga O, Futakawa N, Bin Z, et al. Three generations of hereditary chronic pancreatitis. Hepatogastroenterology. 1999;46(26):1192–8.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Roberto Pozzi Mucelli
    • 1
  • Riccardo Negrelli
    • 1
  • Matteo Catania
    • 1
  • Marco Chincarini
    • 1
  1. 1.Department of RadiologyPoliclinico G. B. Rossi – University Hospital of VeronaVeronaItaly

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