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Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Aim

To evaluate the magnetic resonance (MR) imaging-MR cholangiopancreatographic (MRCP) findings of focal forms of autoimmune pancreatitis (AIP) to describe ductal involvement at diagnosis.

Methods

MR examinations of 123 patients affected by AIP were analysed. We included 26 patients who satisfied International Consensus Diagnostic Criteria and were suffering from focal AIP. Image analysis included: site of parenchymal enlargement, main pancreatic duct (MPD) diameter, MPD stenosis, stricture length, presence of upstream dilation within the stricture, signal intensity, and pancreatic enhancement.

Results

Signal intensity abnormalities were localized in the head in 10/26 (38.5 %) and in the body-tail in 16/26 (61.5 %) patients. MRCP showed a single MPD stenosis in 12/26 (46.1 %) and multiple MPD stenosis in 14/26 (53.8 %) patients, without a dilation of the upstream MPD (mean: 3.83 mm). Lesions showed hypointensity on T1-weighted images in all patients, and hyperintensity on T2-weighted images in 22/26 (84.6 %) patients. The affected parenchyma was hypovascular during the arterial phase in 25/26 (96.2 %) patients with contrast retention.

Conclusions

MR-MRCP are effective techniques for the diagnosis of AIP showing the loss of the physiological lobulation and the typical contrastographic appearance. The presence of multiple, long stenoses without an upstream MPD dilation at MRCP suggests the diagnosis of AIP, and can be useful in differential diagnosis of pancreatic adenocarcinoma.

Key Points

• MRI represents the gold standard in the diagnosis of AIP.

• MRCP is an increasingly useful technique in the diagnosis of focal AIP.

• MRCP could be a problem-solving tool in the differential diagnosis of AIP.

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References

  1. Finkelberg DL, Sahani D, Deshpande V, Brugge WR (2006) Autoimmune pancreatitis. N Engl J Med 355:2670–2676

    Article  CAS  PubMed  Google Scholar 

  2. Manfredi R, Graziani R, Cicero C et al (2008) Autoimmune pancreatitis: CT patterns and their changes after steroid treatment. Radiology 247:435–443

    Article  PubMed  Google Scholar 

  3. Okazaki K, Chiba T (2002) Autoimmune related pancreatitis. Gut 51:1–4

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Yoshida K, Toki F, Takeuchi T, Watanabe S, Shiratori K, Hayashi N (1995) Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 40:1561–1568

    Article  CAS  PubMed  Google Scholar 

  5. Manfredi R, Frulloni L, Mantovani W, Bonatti M, Graziani R, Pozzi Mucelli R (2011) Autoimmune pancreatitis: pancreatic and extrapancreatic MR imaging-MR cholangiopancreatography findings at diagnosis, after steroid therapy, and at recurrence. Radiology 260:428–436

    Article  PubMed  Google Scholar 

  6. Kloppel G, Luttges J, Lohr M, Zamboni G, Longnecker D (2003) Autoimmune pancreatitis: pathological, clinical, and immunological features. Pancreas 27:14–19

    Article  PubMed  Google Scholar 

  7. Kloppel G, Sipos B, Zamboni G, Kojima M, Morohoshi T (2007) Autoimmune pancreatitis: histo- and immunopathological features. J Gastroenterol 42:28–31

    Article  PubMed  Google Scholar 

  8. Zamboni G, Luttges J, Capelli P et al (2004) Histopathological features of diagnostic and clinical relevance in autoimmune pancreatitis: a study on 53 resection specimens and 9 biopsy specimens. Virchows Arch 445:552–563

    Article  PubMed  Google Scholar 

  9. Frulloni L, Amodio A, Katsotourchi AM, Vantini I (2011) A practical approach to the diagnosis of autoimmune pancreatitis. World J Gastroenterol 17:2076–2079

    Article  PubMed Central  PubMed  Google Scholar 

  10. Vlachou PA, Khalili K, Jang HJ, Fischer S, Hirschfield GM, Kim TK (2011) IgG4-related sclerosing disease: autoimmune pancreatitis and extrapancreatic manifestations. Radiographics 31:1379–1402

    Article  PubMed  Google Scholar 

  11. Frulloni L, Scattolini C, Falconi M et al (2009) Autoimmune pancreatitis: differences between the focal and diffuse forms in 87 patients. Am J Gastroenterol 104:2288–2294

    Article  PubMed  Google Scholar 

  12. Carbognin G, Girardi V, Biasiutti C et al (2009) Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP. Radiol Med 114:1214–1231

    Article  CAS  PubMed  Google Scholar 

  13. Chari ST, Kloeppel G, Zhang L et al (2010) Histopathologic and clinical subtypes of autoimmune pancreatitis: the Honolulu consensus document. Pancreas 39:549–554

    Article  CAS  PubMed  Google Scholar 

  14. Chari ST, Smyrk TC, Levy MJ et al (2006) Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 4:1010–1016, quiz 1934

    Article  PubMed  Google Scholar 

  15. Kamisawa T, Yoshiike M, Egawa N, Nakajima H, Tsuruta K, Okamoto A (2005) Treating patients with autoimmune pancreatitis: results from a long-term follow-up study. Pancreatology 5:234–238, discussion 238-240

    Article  PubMed  Google Scholar 

  16. Kim KP, Kim MH, Song MH, Lee SS, Seo DW, Lee SK (2004) Autoimmune chronic pancreatitis. Am J Gastroenterol 99:1605–1616

    Article  PubMed  Google Scholar 

  17. Sugumar A, Chari ST (2009) Distinguishing pancreatic cancer from autoimmune pancreatitis: a comparison of two strategies. Clin Gastroenterol Hepatol 7:S59–S62

    Article  PubMed  Google Scholar 

  18. Sugumar A, Chari ST (2010) Diagnosis and treatment of autoimmune pancreatitis. Curr Opin Gastroenterol 26:513–518

    Article  PubMed  Google Scholar 

  19. Sahani DV, Kalva SP, Farrell J et al (2004) Autoimmune pancreatitis: imaging features. Radiology 233:345–352

    Article  PubMed  Google Scholar 

  20. Kamisawa T, Chen PY, Tu Y et al (2006) MRCP and MRI findings in 9 patients with autoimmune pancreatitis. World J Gastroenterol 12:2919–2922

    PubMed Central  PubMed  Google Scholar 

  21. Lerch MM, Mayerle J (2011) The benefits of diagnostic ERCP in autoimmune pancreatitis. Gut 60:565–566

    Article  PubMed  Google Scholar 

  22. Shimosegawa T, Chari ST, Frulloni L et al (2011) International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreas 40:352–358

    Article  PubMed  Google Scholar 

  23. Sun GF, Zuo CJ, Shao CW, Wang JH, Zhang J (2013) Focal autoimmune pancreatitis: radiological characteristics help to distinguish from pancreatic cancer. World J Gastroenterol 19:3634–3641

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wakabayashi T, Kawaura Y, Satomura Y et al (2003) 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 98:2679–2687

    Article  PubMed  Google Scholar 

  25. Chari ST, Takahashi N, Levy MJ et al (2009) A diagnostic strategy to distinguish autoimmune pancreatitis from pancreatic cancer. Clin Gastroenterol Hepatol 7:1097–1103

    Article  CAS  PubMed  Google Scholar 

  26. D'Onofrio M, Gallotti A, Pozzi Mucelli R (2010) Imaging techniques in pancreatic tumors. Expert Rev Med Devices 7:257–273

    Article  PubMed  Google Scholar 

  27. Kim JH, Byun JH, Kim SY et al (2013) Sclerosing cholangitis with autoimmune pancreatitis versus primary sclerosing cholangitis: comparison on endoscopic retrograde cholangiography, MR cholangiography, CT, and MRI. Acta Radiol 54:601–607

    Article  PubMed  Google Scholar 

  28. Sugumar A, Chari ST (2011) Autoimmune pancreatitis. J Gastroenterol Hepatol 26:1368–1373

    PubMed  Google Scholar 

  29. Kamisawa T, Imai M, Yui Chen P et al (2008) Strategy for differentiating autoimmune pancreatitis from pancreatic cancer. Pancreas 37:e62–e67

    Article  PubMed  Google Scholar 

  30. Sugumar A, Takahashi N, Chari ST (2010) Distinguishing pancreatic cancer from autoimmune pancreatitis. Curr Gastroenterol Rep 12:91–97

    Article  PubMed  Google Scholar 

  31. McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A (2001) Multi–detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220:97–102

    Article  CAS  PubMed  Google Scholar 

  32. Irie H, Honda H, Baba S et al (1998) Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol 170:1323–1327

    Article  CAS  PubMed  Google Scholar 

  33. Tabata T, Kamisawa T, Takuma K, Hara S, Kuruma S, Inaba Y (2012) Differences between diffuse and focal autoimmune pancreatitis. World J Gastroenterol 18:2099–2104

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Dechoux S, Arrive L (2011) IgG4-related sclerosing disease: autoimmune pancreatitis (AIP) and IgG4-related cholangitis. Clin Res Hepatol Gastroenterol 35:601

    Article  CAS  PubMed  Google Scholar 

  35. Frulloni L, Lunardi C (2011) Serum IgG4 in autoimmune pancreatitis: a marker of disease severity and recurrence? Dig Liver Dis 43:674–675

    Article  PubMed  Google Scholar 

  36. Nishino T, Toki F, Oyama H et al (2005) Biliary tract involvement in autoimmune pancreatitis. Pancreas 30:76–82

    PubMed  Google Scholar 

  37. Ohara H, Nakazawa T, Ando T, Joh T (2007) Systemic extrapancreatic lesions associated with autoimmune pancreatitis. J Gastroenterol 42:15–21

    Article  PubMed  Google Scholar 

  38. Takahashi N, Kawashima A, Fletcher JG, Chari ST (2007) Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology 242:791–801

    Article  PubMed  Google Scholar 

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Acknowledgements

The scientific guarantor of this publication is Roberto Pozzi Mucelli. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. We consulted a colleague with significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, G.B. Rossi University Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy

    Riccardo Negrelli, Riccardo Manfredi, Beatrice Pedrinolla, Enrico Boninsegna, Anna Ventriglia, Sara Mehrabi & Roberto Pozzi Mucelli

  2. Department of Gastroenterology, Policlinico G.B. Rossi, Università di Verona, Verona, Italy

    Luca Frulloni

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  1. Riccardo Negrelli
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  2. Riccardo Manfredi
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Correspondence to Riccardo Negrelli.

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Negrelli, R., Manfredi, R., Pedrinolla, B. et al. Pancreatic duct abnormalities in focal autoimmune pancreatitis: MR/MRCP imaging findings. Eur Radiol 25, 359–367 (2015). https://doi.org/10.1007/s00330-014-3371-y

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  • DOI: https://doi.org/10.1007/s00330-014-3371-y

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