Advertisement

CT and MRI Features

  • Ali D. Karaosmanoglu
  • Naoki Takahashi
  • Dushyant V. Sahani
Chapter

Abstract

Autoimmune pancreatitis (AIP) is a recently defined clinical entity. It is an uncommon disease with unique clinical and histological manifestations. It can be classified under the umbrella term of “chronic pancreatitis” and was first reported with the name of “lymphoplasmacytic sclerosing pancreatitis with cholangitis” in 1991. The term “autoimmune pancreatitis” was introduced in 1995. The clinical signs and symptoms mimic multiple diseases and early diagnosis is often difficult. The main pathologic abnormality is the infiltration of the pancreatic periductal areas with lymphocytes and plasma cells with subsequent destruction of the duct epithelium and venulitis [1]. Imaging plays a fundamental role in the diagnosis with some unique features that can be used to avoid a delayed diagnosis. Cross-sectional imaging can provide key findings to aid in the diagnosis and help avoid unnecessary testing and even surgery. In this chapter, we present the imaging findings associated with the pancreatic manifestations seen in patients with IgG4-related disease (IgG4-RD).

Keywords

Bile Duct Pancreatic Duct Main Pancreatic Duct Sclerosing Cholangitis Extrahepatic Bile Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kloppel G, Luttges J, Sipos B, et al. Autoimmune pancreatitis: pathological findings. JOP. 2005;6(1 suppl):97–101.PubMedGoogle Scholar
  2. 2.
    Hamano H, Kawa S, Horiuchi A, et al. High serum IgG4 concentrations in patients with sclerosing pancreatitis. N Engl J Med. 2001;344:732–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Kamisawa T, Funata N, Hayashi Y. Lymphoplasmacytic sclerosing pancreatitis is a pancreatic lesion of IgG4-related diseases (IgG4-RD). Am J Surg Pathol. 2004;28:1114.PubMedCrossRefGoogle Scholar
  4. 4.
    Okazaki K, Kawa S, Kamisawa T, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: I. Concept and diagnosis of autoimmune pancreatitis. J Gastroenterol. 2010;45:249–65.PubMedCrossRefGoogle Scholar
  5. 5.
    Yang DH, Kim KW, Kim TK, et al. Autoimmune pancreatitis: radiologic findings in 20 patients. Abdom Imaging. 2006;31:94–102.PubMedCrossRefGoogle Scholar
  6. 6.
    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 Gastroeterol. 2003;98:2679–87.CrossRefGoogle Scholar
  7. 7.
    Inoue K, Ohuchida J, Ohtsuka T, et al. Severe localized stenosis and marked dilatation of the main pancreatic duct are indicators of pancreatic cancer instead of chronic pancreatitis on endoscopic retrograde balloon pancreatography. Gastrointest Endosc. 2003;58:510–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Kawamoto S, Siegelman SS, Hruban RH, et al. Lymphoplasmacytic sclerosing pancreatitis (autoimmune pancreatitis): evaluation with multidetector CT. Radiographics. 2008;28:157–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Kawa S, Okazaki K, Kamisawa T, et al. Japanese consensus guidelines for management of autoimmune pancreatitis: II. Extrapancreatic lesions, differential diagnosis. J Gastroenterol. 2010;45:355–69.PubMedCrossRefGoogle Scholar
  10. 10.
    Sahani DV, Kalva SP, Farrell J, et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233:345–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Kamisawa T, Chen PY, Tu Y, et al. MRCP and MRI findings in 9 patients with autoimmune pancreatitis. World J Gastroenterol. 2006;12(18):2919–22.PubMedGoogle Scholar
  12. 12.
    Nishino T, Oyama H, Hashimoto E, et al. Clinicopathological differentiation between sclerosing cholangitis with autoimmune pancreatitis and primary sclerosing cholangitis. J Gastroenterol. 2007;42:550–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Okazaki K, Uchida K, Chiba T. Recent concept of autoimmune-related pancreatitis. J Gastroenterol. 2001;36:293–302.PubMedCrossRefGoogle Scholar
  14. 14.
    Nishino T, Toki F, Oyama H, et al. Biliary tract involvement in autoimmune pancreatitis. Pancreas. 2005;30:76–82.PubMedGoogle Scholar
  15. 15.
    Detlefsen S, Drewes AM. Autoimmune pancreatitis. Scand J Gastroenterol. 2009;44:1391–407.PubMedCrossRefGoogle Scholar
  16. 16.
    Kamisawa T, Anjiki H, Egawa N. Rapid changes in sclerosing cholangitis associated with autoimmune pancreatitis. Pancreas. 2009;38:601–2.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim KP, Kim MH, Song MH, et al. Autoimmune chronic pancreatitis. Am J Gastroenterol. 2004;99:1605–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Kloppel G, Luttges J, Lohr M, et al. Autoimmune pancreatitis: pathological, clinical, and immunological features. Pancreas. 2003;27:14–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Pearson RK, Longnecker DS, Chari ST, et al. Controversies in clinical pancreatology: autoimmune pancreatitis-does it exist? Pancreas. 2003;27:1–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Yoshida H, Tanaka S, Nagayama Y, et al. Autoimmune pancreatitis associated with ulcerative colitis (in Japanese). J Gastroenterol Imaging. 2002;4:66–74.Google Scholar
  21. 21.
    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;27:1119–27.PubMedCrossRefGoogle Scholar
  22. 22.
    Kamisawa T, Funata N, Hayashi Y, et al. Close relationship between auto-immune pancreatitis and multifocal fibrosis. Gut. 2003;52:683–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Nakazawa T, Ohara H, Sano H, et al. Clinical differences between primary sclerosing cholangitis and sclerosing cholangitis with autoimmune pancreatitis. Pancreas. 2005;30:20–5.PubMedGoogle Scholar
  24. 24.
    Yoshizaki K, 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.Google Scholar
  25. 25.
    Muraki T, Ozaki Y, Hamano H, et al. Ultrasonographic diagnosis of autoimmune pancreatitis. Biliary Tract Pancreas. 2005;26:711–6.Google Scholar
  26. 26.
    Nakanuma Y, Zen Y. Pathology and immunopathology of immunoglobulin G4-related sclerosing cholangitis: the latest addition to the sclerosing cholangitis family. Hepatol Res. 2007;37:S478–86.PubMedCrossRefGoogle Scholar
  27. 27.
    Zamboni G, Luttges 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;445:552–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Hyodo N, Hyodo T. Ultrasonographic evaluation in patients with autoimmune-related pancreatitis. J Gastroenterol. 2003;38:1155–61.PubMedCrossRefGoogle Scholar
  29. 29.
    Kawamoto S, Siegelman SS, Hruban RH, et al. Lymphoplasmacytic sclerosing pancreatitis with obstructive jaundice: CT and pathology features. Am J Roentgenol. 2004;183(4):915–21.CrossRefGoogle Scholar
  30. 30.
    Nikfarjam M, Muralidharan V, Christophi C, et al. Autoimmune pancreatitis. ANZ J Surg. 2002;72(6):450–2.PubMedCrossRefGoogle Scholar
  31. 31.
    Nakazawa T, Ohara H, Sano H, et al. Cholangiography can discriminate sclerosing cholangitis with autoimmune pancreatitis from primary sclerosing cholangitis. Gastrointest Endosc. 2004;60:937–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Sugumar A, Chari ST. Distinguishing pancreatic cancer from autoimmune pancreatitis: a comparison of two strategies. Clin Gastroenterol Hepatol. 2009;7(11 Suppl):59–62.CrossRefGoogle Scholar
  33. 33.
    Kamisawa T, Okamoto A, Wakabayashi T, et al. Appropriate steroid therapy for autoimmune pancreatitis based on long-term outcome. Scand J Gastroenterol. 2008;43:609–13.PubMedCrossRefGoogle Scholar
  34. 34.
    Kamisawa T, Egawa N, Nakajima H, et al. Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol. 2003;98(12):2694–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Procacci C, Carbognin G, Biasiutti C, et al. Autoimmune pancreatitis: possibilities of CT characterization. Pancreatology. 2001;1(3):246–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Bjornsson E, Chapman RW. Sclerosing cholangitis. Curr Opin Gastroenterol. 2003;19:270–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Snook JA, Chapman RW, Fleming K, et al. Anti-neutrophil nuclear antibody in ulcerative colitis, Crohn’s disease and primary sclerosing cholangitis. Clin Exp Immunol. 1989;76:30–3.PubMedGoogle Scholar
  38. 38.
    Webster GJM, Pereira SP, Chapman RW. Autoimmune pancreatitis/IgG4-associated cholangitis and primary sclerosing cholangitis-overlapping or separate diseases. J Hepatol. 2009;51:398–402.PubMedCrossRefGoogle Scholar
  39. 39.
    Björnsson E, Chari ST, Smyrk TC, et al. Immunoglobulin G4 associated cholangitis: description of an emerging clinical entity based on review of the literature. Hepatology. 2007;45:1547–54.PubMedCrossRefGoogle Scholar
  40. 40.
    Angulo P, Lindor KD. Primary sclerosing cholangitis. Hepatology. 1999;30:325–32.PubMedCrossRefGoogle Scholar
  41. 41.
    Chen W, Gluud C. Glucocorticosteroids for primary sclerosing cholangitis. Cochrane Database Syst Rev. 2004;3, CD004036.PubMedGoogle Scholar
  42. 42.
    Menias CO, Surabhi VR, Prasad SR, et al. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics. 2008;28:111–1129.CrossRefGoogle Scholar
  43. 43.
    Park MS, Yu JS, Kim KW, et al. Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology. 2001;220:677–82.PubMedCrossRefGoogle Scholar
  44. 44.
    Zen Y, Harada K, Sasaki M, et al. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: do they belong to a spectrum of sclerosing pancreatitis? Am J Surg Pathol. 2004;28:1193–203.PubMedCrossRefGoogle Scholar
  45. 45.
    Abraham SC, Cruz-Correa M, Argani P, et al. lymphoplasmacytic chronic cholecystitis and biliary tract disease in patients lymphoplasmacytic sclerosing pancreatitis. Am J Surg Pathol. 2003;27:441–51.PubMedCrossRefGoogle Scholar
  46. 46.
    Kamisawa T, Tu Y, Nakajima H, et al. Sclerosing cholecystitis associated with autoimmune pancreatitis. World J Gastroenterol. 2006;12(23):3736–9.PubMedGoogle Scholar
  47. 47.
    Lewis JT, Talwalkar JA, Rosen CB, et al. Prevalence and risk factors for gallbladder neoplasia in patients with primary sclerosing cholangitis: evidence for a metaplasia-dysplasia-carcinoma sequence. Am J Surg Pathol. 2007;31:907–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ali D. Karaosmanoglu
    • 1
  • Naoki Takahashi
    • 2
  • Dushyant V. Sahani
    • 1
  1. 1.Department of RadiologyMassachusetts General Hospital (ADK, DS)BostonUSA
  2. 2.Department of RadiologyMayo ClinicRochesterUSA

Personalised recommendations