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Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP

Pancreatiti autoimmuni: rilievi RM con mezzo di contrasto e CPRM con secretina

  • Abdominal Radiology/Radiologia Addominale
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study retrospectively determined magnetic resonance (MR), MR cholangiopancreatography (MRCP) and secretin-MRCP findings in patients with autoimmune pancreatitis (AIP).

Materials and methods

The MR examinations of 28 patients with histopathologically proven AIP were reviewed. In 14 cases, secretin-enhanced MRCP was performed. The observers evaluated pancreatic parenchymal enlargement, signal intensity abnormalities, enhancement, vascular involvement, bile-duct diameter and main pancreatic duct (MPD) narrowing (diffuse/focal/segmental). After secretin administration, the presence of the “duct-penetrating” sign was evaluated.

Results

MR imaging showed diffuse pancreatic enlargement in 8/28(29%) cases, focal pancreatic enlargement in 16/28 (57%) cases and no enlargement in 4/28 (14%) cases. The alteration of pancreatic signal intensity was diffuse in 8/28 (29%) cases (eight diffuse AIP) and focal in 20/28 (71%) cases (20 focal AIP). Delayed pancreatic enhancement was present in all AIP, with peripheral rim of enhancement in 8/28 (29%) AIP (1/8 diffuse, 7/20 focal); vascular encasement was present in 7/28 (25%) AIP (1/8 diffuse, 6/20 focal); distal common bile duct narrowing was present in 12/28(43%) AIP (5/8 diffuse, 7/20 focal). MRCP showed MPD narrowing in 17/28 (61%) AIP (4/8 diffuse, 15/20 focal), MPD dilation in 8/28(29%) AIP (3/8 diffuse, 5/20 focal) and normal MPD in1/8 diffuse AIP. Secretin-MRCP showed the duct-penetrating sign in 6/14(43%) AIP (one diffuse AIP with MPD segmental narrowing, five focal AIP with MPD focal narrowing), demonstrating integrity of the MPD.

Conclusions

Delayed enhancement and MPD stenosis are suggestive for AIP on MR and MRCP imaging. Secretin-enhanced MRCP is a problem-solving tool in the differential diagnosis between focal AIP and ductal adenocarcinoma.

Riassunto

Obiettivo

Scopo di questo lavoro è stato valutare i rilievi di pancreatite autoimmune (AIP) nella revisione retrospettiva delle immagini di risonanza magnetica (RM), colangiopancreatografia-RM (CPRM) e CPRM con secretina.

Materiali e metodi

È stata valutata l’indagine RM di 28 pazienti con diagnosi patologica di AIP; in 14 casi è stato espletato l’esame CPRM con somministrazione di secretina. Le immagini sono state analizzate considerando i seguenti parametri: volume del pancreas, alterazioni dell’intensità di segnale del parenchima, impregnazione del pancreas, coinvolgimento vascolare, calibro delle vie biliari e restringimento (diffuso/focale/segmentale) del dotto pancreatico principale (DPP). Dopo somministrazione di secretina, è stata verificata la presenza del segno del “dotto penetrante”.

Risultati

L’esame RM ha evidenziato un incremento dimensionale diffuso del pancreas in 8/28 (29%) casi, un ingrandimento di una parte del pancreas - focale - in 16/28 (57%) casi e pancreas di regolare dimensione in 4/28 (14%) casi. L’alterazione dell’intensità di segnale del pancreas era diffusa in 8/28 (29%) casi (8 AIP di tipo diffuso) e focale in 20/28 (71%) casi (20 AIP di tipo focale). Impregnazione pancreatica tardiva con “cercine” periferico iperintenso si è rilevata in 8/28 (29%) AIP (1/8 AIP di tipo diffuso, 7/20 AIP di tipo focale); “encasement” vascolare è stato dimostrato in 7/28 (25%) AIP (1/8 AIP di tipo diffuso, 6/20 AIP di tipo focale); restringimento del dotto biliare comune è stato rilevato in 12/28 (43%) AIP (5/8 AIP di tipo diffuso, 7/20 AIP di tipo focale). L’esame CPRM ha mostrato restringimento del DPP in 17/28 (61%) AIP (4/8 AIP di tipo diffuso, 15/20 AIP di tipo focale), dilatazione del DPP in 8/28 (29%) AIP (3/8 AIP di tipo diffuso, 5/20 AIP di tipo focale), e DPP normale in 1 AIP di tipo diffuso. L’esame CPRM con secretina ha fatto rilevare il segno del “dotto penetrante” in 6/14 (43%) AIP (1 caso di AIP diffusa con restringimento segmentale del DPP, 5 casi di AIP focale con restringimento focale del DPP) dimostrano l’integrità del DPP.

Conclusioni

All’indagine RM e CPRM, il pattern di impregnazione tardivo e l’assotigliamento del DPP sono reperti suggestivi di AIP. La somministrazione di secretina durante l’esame CPRM è uno strumento utile nella diagnosi differenziale tra AIP di tipo focale e adenocarcinoma duttale.

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Authors and Affiliations

  1. Department of Radiology, University of Verona, P.le Scuro 10, 37134, Verona, Italy

    G. Carbognin, V. Girardi, C. Biasiutti, L. Camera, R. Manfredi & R. Pozzi Mucelli

  2. Department of Biomedical and Surgical Science, University of Verona, P.le Scuro 10, 37134, Verona, Italy

    L. Frulloni

  3. Medical Center Rotterdam, Erasmus University, 3000, CA Rotterdam, The Netherlands

    J.J. Hermans

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  1. G. Carbognin
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  2. V. Girardi
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  3. C. Biasiutti
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  4. L. Camera
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  5. R. Manfredi
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  6. L. Frulloni
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Correspondence to V. Girardi.

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Carbognin, G., Girardi, V., Biasiutti, C. et al. Autoimmune pancreatitis: imaging findings on contrast-enhanced MR, MRCP and dynamic secretin-enhanced MRCP. Radiol med 114, 1214–1231 (2009). https://doi.org/10.1007/s11547-009-0452-0

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  • DOI: https://doi.org/10.1007/s11547-009-0452-0

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