Cross-sectional imaging-based severity scoring of chronic pancreatitis: why it is necessary and how it can be done
- 16 Downloads
Chronic pancreatitis (CP) remains a diagnostic challenge as clinical symptoms are non-specific, histopathological appearances are varied and pathogenesis remains incompletely understood. Multiple classifications and grading systems have been proposed for CP, but none leverage the full capabilities of cross-sectional imaging modalities and are not widely accepted or validated. CT and MRI/MRCP are useful in identifying a wide spectrum of histopathological changes in CP and can also assess exocrine reserve of pancreas. Advanced MRI techniques such as T1 mapping and extracellular volume fraction can potentially identify early CP. Cross-sectional imaging-based severity scoring can quantify CP disease burden and may have positive implications for clinicians and researchers. In this review, we discuss the need for cross-sectional imaging-based severity scoring for CP, role of CT, and MRI/MRCP in assessment of CP and how these modalities can be used to obtain severity scoring for CP. We summarize relevant information from recently published CT and MRI/MRCP reporting standards for CP, and from international guidelines for cross-sectional imaging and severity scoring for CP.
KeywordsChronic pancreatitis Multidetector computed tomography Magnetic resonance imaging Classification
The authors would like to thank Dr. Dhiraj Yadav, Professor of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh School of Medicine, for reviewing the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Duggan SN, Chonchubhair HMN, Lawal O, O’Connor DB, Conlon KCJWjog. Chronic pancreatitis: A diagnostic dilemma. 2016;22(7):2304Google Scholar
- 6.Whitcomb DC, Shimosegawa T, Chari ST, Forsmark CE, Frulloni L, Garg P, et al. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology. 2018.Google Scholar
- 15.Tirkes T, Shah ZK, Takahashi N, Grajo JR, Chang ST, Venkatesh SK, et al. Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology. 2019;290(1):207-15CrossRefGoogle Scholar
- 19.Tirkes T, Yadav D, Conwell DL, Territo PR, Zhao X, Venkatesh SK, et al. Magnetic resonance imaging as a non-invasive method for the assessment of pancreatic fibrosis (MINIMAP): a comprehensive study design from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Abdom Radiol (NY). 2019;44(8):2809-21CrossRefGoogle Scholar
- 21.Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nature Reviews Disease Primers. 2017;3:nrdp201760.Google Scholar
- 22.Ulzheimer S, Bongers M, Flohr T. Multi-slice CT: Current Technology and Future Developments. 2018.Google Scholar
- 26.Zhang XM, Shi H, Parker L, Dohke M, Holland GA, Mitchell DG. Suspected early or mild chronic pancreatitis: enhancement patterns on gadolinium chelate dynamic MRI. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2003;17(1):86-94CrossRefGoogle Scholar
- 27.Balci NC, Alkaade S, Magas L, Momtahen AJ, Burton FR. Suspected chronic pancreatitis with normal MRCP: findings on MRI in correlation with secretin MRCP. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;27(1):125-31CrossRefGoogle Scholar
- 32.Gillams A, Punwani S, Smart S, Lees W, editors. Quantification of Pancreatic Exocrine Function Using Secretln Stimulated MRCP.Google Scholar
- 38.Tirkes T, Mitchell JR, Li L, Zhao X, Lin C. Normal T1 relaxometry and extracellular volume of the pancreas in subjects with no pancreas disease: correlation with age and gender. Abdom Radiol (NY). 2019.Google Scholar
- 39.Akisik MF, Sandrasegaran K, Jennings SG, Aisen AM, Lin C, Sherman S, et al. Diagnosis of chronic pancreatitis by using apparent diffusion coefficient measurements at 3.0-T MR following secretin stimulation. Radiology. 2009;252(2):418-25.Google Scholar
- 40.Cho SG, Lee DH, Lee KY, Ji H, Lee KH, Ros PR, et al. Differentiation of chronic focal pancreatitis from pancreatic carcinoma by in vivo proton magnetic resonance spectroscopy. 2005;29(2):163-9Google Scholar
- 45.Sai JK, Suyama M, Kubokawa Y, Watanabe S. Diagnosis of mild chronic pancreatitis (Cambridge classification): comparative study using secretin injection-magnetic resonance cholangiopancreatography and endoscopic retrograde pancreatography. World journal of gastroenterology: WJG. 2008;14(8):1218CrossRefGoogle Scholar
- 48.Wu C, Li F, Niu G, Chen X. PET imaging of inflammation biomarkers. Theranostics. 2013;3(7):448Google Scholar