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Autoimmune Pancreatitis

  • Kazuichi Okazaki
Chapter

Abstract

This chapter outlines aspects of pancreatic imaging for type 1 autoimmune pancreatitis (AIP). AIP is subclassified as either type 1 (IgG4-related) or type 2 (granulocytic epithelial lesions) according to the International Consensus of Diagnostic Criteria for Autoimmune Pancreatitis. The imaging modalities reviewed are ultrasound (US), computed tomography (CT), and magnetic resonance (MR). Indications for endoscopic retrograde pancreatography (ERP) are also discussed in the context of the imaging findings.

When diffuse, sausage-like swelling of the pancreas is demonstrated on US, CT, or MRI, ERP is generally unnecessary. Conversely, when only localized swelling is detected on imaging, ERP is essential to exclude pancreatic cancer. The US findings in the pancreatic parenchyma characteristic of AIP are a hypoechoic area with scattered hyperechoic spots within the region of swelling. Contrast-enhanced CT and MRI demonstrate delayed enhancement and a capsule-like rim around the pancreas in AIP.

ERP and magnetic resonance pancreatography (MRP) can reveal irregular narrowings within the main pancreatic duct. These irregular narrowings can be either localized or distributed diffusely within the duct. Side branches arising from narrowed portions of the main pancreatic duct and (noncontinuous) multiple main pancreatic duct (skip lesions) are useful findings in the differentiation from pancreatic cancer. MRP cannot yet characterize irregular narrowing in the main pancreatic duct with sufficient accuracy to exclude pancreatic cancer, but skip lesions are useful to support the diagnosis. ERP is still required to distinguish these lesions in many clinical settings.

Keywords

Pancreatic Cancer Pancreatic Duct Main Pancreatic Duct Pancreatic Parenchyma Autoimmune Pancreatitis 
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.
    Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci. 1995;40:1561–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Stone JH, Khosroshahi A, Deshpande V, et al. Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations. Arthritis Rheum. 2012;64(10):3061–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Shimosegawa T, Chari ST, Frulloni L, et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the international association of pancreatology. Pancreas. 2011;40:352–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Sugumar A, Klöppel G, Chari ST. Autoimmune pancreatitis: pathologic subtypes and their implications for its diagnosis. Am J Gastroenterol. 2009;104:2308–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Okazaki K, Kawa S, Kamisawa T, et al. Japanese clinical guidelines for autoimmune pancreatitis. Pancreas. 2009;38(8):849–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Kawaguchi K, Koike M, Tsuruta K, et al. Lymphoplasmacytic sclerosing pancreatitis with cholangitis: a variant of primary sclerosing cholangitis extensively involving pancreas. Hum Pathol. 1991;22(4):387–95.CrossRefPubMedGoogle Scholar
  7. 7.
    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(8):1119–27.CrossRefPubMedGoogle Scholar
  8. 8.
    Zamboni G, Lüttges 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(6):552–63.CrossRefPubMedGoogle Scholar
  9. 9.
    The Japanese Pancreas Society the Ministry of Health and Welfare Investigation Research Team for Intractable Pancreatic Disease: clinical diagnostic criteria for autoimmune pancreatitis 2011 (proposal). Suizo.2012;27:17–25Google Scholar
  10. 10.
    Okazaki K, Kawa S, Kamisawa T, et al. Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol. 2006;41(7):626–31.CrossRefPubMedGoogle Scholar
  11. 11.
    The Research Committee of Intractable Diseases of the Pancreas supported by the Japanese Ministry of Health, Labour and Welfare. Atlas of autoimmune pancreatitis (in Japanese): Arcmedium; 2007:1–54Google Scholar
  12. 12.
    Haaga JR, Alfidi RJ, Zelch MG, et al. Computed tomography of the pancreas. Radiology. 1976;120(3):589–95.PubMedGoogle Scholar
  13. 13.
    Sarner M, Cotton PB. Classification of pancreatitis. Gut. 1984;25(7):756–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Yoshizaki H, 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
  15. 15.
    Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol. 1998;170(5):1323–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sahani DV, Kalva SP, Farrell J, et al. Autoimmune pancreatitis: imaging features. Radiology. 2004;233(2):345–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Nakamoto Y, Sakahara H, Higashi T, et al. Autoimmune pancreatitis with F-18 fluoro-2-deoxy-D-glucose PET findings. Clin Nucl Med. 1999;24(10):778–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Saegusa H, Momose M, Kawa S, et al. Hilar and pancreatic gallium-67 accumulation is characteristic feature of autoimmune pancreatitis. Pancreas. 2003;27(1):20–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Toki F, Kozu T, Oi I. An unusual type of chronic pancreatitis showing diffuse narrowing of the entire main pancreatic duct on ERCP. A report of four cases. (abstract). Endoscopy. 1992;24:640.Google Scholar
  20. 20.
    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 Gastroenterol. 2003;98:2679–87.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, The third Department of Internal MedicineKansai Medical UniversityMoriguchi CityJapan

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