eMedicine Specialties > Radiology > Gastrointestinal
Pancreatitis, Chronic: Imaging
Updated: Mar 12, 2009
Radiography
Chronic pancreatitis. Plain abdominal radiograph shows coarse calcification in the distribution of the pancreas due to chronic calcific pancreatitis.
Chronic pancreatitis. Plain abdominal radiograph shows calcification in the pancreas associated with osteomalacia secondary to malabsorption. Note the pseudofracture in the right 11th rib (arrow).
Chronic pancreatitis. Upper gastrointestinal tract barium study shows a reverse 3 in the duodenum due to chronic pancreatitis. Pancreatic carcinoma can have a similar appearance.
Chronic pancreatitis. Plain abdominal radiograph (in the same patient as in Images 10-11 in Multimedia) shows a common bile duct stent in situ and fairly extensive pancreatic calcification.
Findings
Plain radiography
Pancreatic calcifications are a common finding in chronic calcific pancreatitis and are considered pathognomonic for alcoholic chronic pancreatitis. Calcification primarily represents intraductal calculi, either in the main pancreatic duct or in the smaller pancreatic ductal radicles. Calcification is punctate or coarse, and it may have a focal, segmental, or diffuse distribution.
Upper GI tract barium series
Even in the age of cross-sectional imaging, upper GI tract barium series may provide information that is critical to the treatment of patients with chronic pancreatitis.
Esophageal involvement rarely occurs in chronic pancreatitis, and obstruction is usually the result of mediastinal extension of a pseudocyst. Pancreatic enlargement or a pseudocyst may compress the stomach. Peripancreatic fibrosis may involve the antrum of the stomach or duodenum, resulting in stenosis. The anatomic proximity of the pancreatic head and stomach antrum is constant, and enlargement of the pancreatic head usually causes effacement of the antrum; this has been termed the pad sign. Chronic pancreatitis may cause gastric nodularity and thickening of the mucosal folds; these findings are most prominent on the posterior aspect.
Gastric varices secondary to splenic venous thrombosis may have similar findings. The C loop of the duodenum may be widened because of mass effect from an enlarged pancreatic head, or it may be present as an inverted 3 sign due to traction on the medial wall of the duodenum. In the duodenum, mucosal changes occur, such as spiculation, flattening, or slight nodularity of the mucosal folds of the medial border of the duodenum or concentric narrowing due to periduodenal fibrosis.
Small-bowel changes infrequently occur in chronic pancreatitis. Displacement and stretching may occur as a result of pseudocysts. Small-bowel changes may occur as a result of exudation of pancreatic enzymes during the early stages of chronic pancreatitis, when the pancreatic secretory function is still intact. The enzymes may affect the mesenteric vessels at their roots, causing small-bowel ischemia, fibrotic stricture, and malabsorption pattern. As a result of the close anatomic relationship between the transverse colon and the pancreas, the pancreatic enzymes have direct access to the colon.
Changes in the colon include thickening of the haustral folds due to mucosal edema and luminal narrowing. These changes are usually confined to the inferior haustral row of the transverse colon and the splenic flexure. Rarely, fistula formation may occur. All 3 of these colon findings are best appreciated on barium enema examination.
Endoscopic retrograde cholangiopancreatography
Earliest changes are observed in side branches of the pancreatic duct, including dilatation without stenosis, dilatation with downstream stenosis, intraluminal mucosal irregularity, and intraluminal filling defects due to protein plugs or calculi. The number of opacified side branches may be reduced in a focal or diffuse manner because of ductal occlusion.
Chronic pancreatitis. Endoscopic retrograde cholangiopancreatogram shows a dilated common bile duct (CBD) associated with a stricture of the lower CBD (not well shown on this image) and a dilated ectatic tortuous pancreatic duct (in the same patient as in Images 11-12). A stent was subsequently placed across the CBD stricture.
In late stages of the disease, changes in the main pancreatic duct are prominent and are similar to those in the side branches, such as ductal dilatation with or without stenosis, short segmental narrowing or long strictures, and intraluminal filling defects due to protein plugs or calculi.
The pancreatic duct may show beading or a chain-of-lakes or string-of-pearls appearance because of alternating stenosis and dilatation of the pancreatic duct.
Small (1-2 cm), round or oval, irregular or well-delineated pancreatic parenchymal cavities may be observed.
Occasionally, contrast material may fill large pseudocysts via fistulous communications. Prolonged emptying of contrast material may be observed.
Common bile duct changes are common in chronic pancreatitis. The most common finding is a long, smooth narrowing of the duct, with gradual tapering of the distal segment due to periductal fibrosis.
In 25% patients with chronic pancreatitis, alternating stenosis and dilation may cause the common bile duct to have an hourglass appearance.
Degree of Confidence
The sensitivity of plain abdominal radiography in the detection of pancreatic calcification is approximately 80%, which is higher than that of sonography but lower than that of CT. When seen, pancreatic calcification is pathognomonic for chronic pancreatitis. Barium study findings can be specific for GI tract changes secondary to chronic pancreatitis in the appropriate clinical setting.
ERCP is the most sensitive and specific technique for chronic pancreatitis, although it is invasive and may cause an acute episode of pancreatitis and ascending cholangitis.
False Positives/Negatives
On anteroposterior radiographs, the spine may mask small punctate calcifications; therefore, the acquisition of additional oblique or lateral images may be indicated. Bowel contents may obscure pancreatic calcification, and calcification in the pancreas and pancreatic bed is not specific for chronic pancreatitis. Causes of pancreatic calcification include acute pancreatitis, cavernous lymphangioma, hemangioma, cystic fibrosis, pancreatic hematoma/infarction, cystadenoma and/or cystadenocarcinoma, islet tumors, metastasis, pseudocysts, and kwashiorkor. Calcification in a vascular atheroma, an aortic aneurysm, or branches of the aorta can occasionally be confused with pancreatic calcification on plain abdominal radiographs.
Gastric displacement seen on barium examination is not specific for chronic pancreatitis and may be due to pancreatic carcinoma, a variety of peripancreatic masses (including adrenal gland or renal masses), aortic aneurysms, exophytic gastric or duodenal tumors, lymphoma and other retroperitoneal tumors, mesenteric cysts, splenic masses, or enlargement of the left lobe of the liver. In some patients, nodular mucosal changes on the medial border of the duodenum may be prominent and may mimic pancreatic carcinoma. Thickened gastric mucosal folds are not specific for chronic pancreatitis; similar thickening can occur with pancreatic carcinoma, lymphoma, gastric carcinoma, gastric sarcoidosis, and Ménétrier disease.
Widening of the duodenal loop is reported as a normal variant, but a similar abnormality is reported with aortic aneurysm; choledochal cysts; duodenal hematoma; retroperitoneal lymphadenopathy; retroperitoneal tumors; parasitic disease; and neoplasms of the stomach, colon, and kidney.
Small-bowel changes in chronic pancreatitis may mimic other causes of intestinal ischemia, Crohn disease, and malabsorption. Colonic changes may mimic vascular ischemia, Crohn disease, and primary colonic carcinoma.
Although ERCP findings can be specific in patients with chronic pancreatitis, they may be confused with those of pancreatic carcinoma in 10% of patients. Such confusion may arise with focal forms of chronic pancreatitis, pancreatic carcinoma extending through the entire pancreas, and coexisting chronic pancreatitis and pancreatic carcinoma.
Intraductal papillary mucinous neoplasm (IPMN) may have imaging findings identical to those of chronic pancreatitis, such as main duct and side-chain dilatation. ERCP can be used to differentiate main duct IPMN from chronic pancreatitis, because the former often shows mucin bulging from the ampulla.
Computed Tomography
Chronic pancreatitis. Nonenhanced axial CT scan through the pancreas shows granular calcification in the pancreas.
Chronic pancreatitis. Enhanced axial CT scan through the pancreas shows a low-attenuating mass at the junction of the head and body of the pancreas due to focal chronic noncalcific pancreatitis.
Chronic pancreatitis. Enhanced axial CT scan through the pancreas (in the same patient as in Image 5) shows a mildly dilated pancreatic duct.
Chronic pancreatitis. Nonenhanced axial CT scan through the pancreas shows granular calcification in the pancreas, associated with a 4-cm pseudocyst to the right of the head of the pancreas.
Chronic pancreatitis. Nonenhanced axial CT scan through the pancreas shows a reverse 3 in the Gastrografin-filled duodenum. Note the patchy attenuation in the head of the pancreas. A contrast-enhanced study was not performed because the patient was allergic to intravenous iodinated contrast material.
Chronic pancreatitis. Nonenhanced axial CT scan through the pancreas (in the same patient as in Images 13-14) shows an enlarged pancreas associated with punctate calcification.
Findings
CT features of chronic pancreatitis include those discussed in Anatomy. Other changes that can be visualized on CT scans are dilatation of the main pancreatic duct; calcifications; changes in size, shape, and contour; pseudocysts; and bile duct changes.8,9
Main pancreatic duct dilatation can be demonstrated, with the width of the main pancreatic duct exceeding 5 mm in the head and 2 mm in the body and tail. CT is the most sensitive and specific modality for depicting pancreatic calcifications, which may be tiny and punctate or larger and coarse. Focal enlargement or atrophy of the pancreas is readily demonstrated on CT scans. Focal enlargement associated with calcification or ductal dilatation in a mass is suggestive of chronic pancreatitis.
Obliteration of the peripancreatic fat, which results in poor definition and an ill-defined pancreatic contour, is usually seen in acute exacerbations of chronic pancreatitis. Obliteration of the fat sleeve around the superior mesenteric artery has been described in both chronic pancreatitis and pancreatic carcinoma.
Obstruction of the common bile duct may be visualized as a gradual tapering of the ductal lumen. By contrast, a pancreatic carcinoma usually results in an abrupt transition of the common bile duct. Vascular complications of chronic pancreatitis are best depicted by contrast-enhanced CT scans. In images of pseudoaneurysms, high-attenuation masses are seen during the arterial phase. Portal and/or splenic vein thrombosis and associated collateral venous channels are better delineated during the portal venous phase of contrast enhancement.
Degree of Confidence
Currently, CT is regarded as the imaging modality of choice for the initial evaluation of suggested chronic pancreatitis. The diagnostic features of pancreatic enlargement, pancreatic calcifications, pancreatic ductal dilatation, thickening of the peripancreatic fascia, and bile duct involvement are depicted well on CT scans.
CT is more sensitive than plain radiography and ultrasonography in the depiction of pancreatic calcification. Moreover, CT depicts calcification in the pancreas, and confusion with nonpancreatic calcification is less likely. The accuracy of CT is 59-95%; the wide variation is due to the wide discrepancy in the criteria used for diagnosis and in the quality of CT scanners. CT helps in the diagnosis of atrophy of the pancreas, providing better results than ultrasonography.
Pancreatic pseudocysts and complications associated with pseudocysts, including various organ involvements, infection, hemorrhage with pseudoaneurysm formation, rupture with fistula formation, and gastrointestinal or biliary obstruction, are well depicted on CT. Detection of these complications are important, as they may necessitate prompt intervention or surgery.8,10
False Positives/Negatives
Chronic pancreatitis and pancreatic carcinoma share many CT features, and occasionally, differentiation may be impossible. Obliteration of the fat sleeve around the superior mesenteric artery has been described in both chronic pancreatitis and pancreatic carcinoma.
Pseudotumoral enlargement around focal pancreatitis with extensive fibrous tissue proliferation usually fails to enhance after the administration of contrast material. This characteristic makes the differential diagnosis of pancreatic carcinoma difficult.
Magnetic Resonance Imaging
Chronic pancreatitis. Transaxial T2-weighted MRI scan through the tail of the pancreas shows a dilated tortuous pancreatic duct (arrow).
Chronic pancreatitis. Magnetic resonance cholangiopancreatogram (in the same patient as in Images 10 and 12) obtained 24 hours after the placement of a common bile duct stent shows good biliary drainage through the stent. Note the dilated tortuous pancreatic stricture and a downstream stricture in the head of the pancreas (left).
Findings
In most patients, a normal pancreatic duct is seen on images obtained with T2-weighted short-tau inversion recovery MRI sequences and MRCP. MRCP may depict the characteristic beaded appearance of the pancreatic duct in chronic pancreatitis. Pancreatic duct calculi are depicted as round filling defects. In chronic pancreatitis, fat-suppressed T1-weighted images usually show a loss of signal intensity. This loss is explained by the fact that pancreatic fibrosis decreases the proteinaceous fluid content of the pancreas, resulting in loss of pancreatic signal intensity. Fibrosis is associated with decreased vascularity, which causes decreased pancreatic gadolinium enhancement.
Small punctate pancreatic calcification is difficult to detect by using MRI, but larger calcifications may be seen as foci of a signal void. As a result of its ability to depict fluid, T2-weighted MRI may demonstrate pancreatic and common bile duct irregularities and pseudocysts associated with chronic pancreatitis.
Parenchymal gadolinium enhancement is a useful technique in evaluating focal areas of inflammation. Compared with normal pancreatic segments, inflamed areas have decreased enhancement in the arterial phase and increased enhancement in the equilibrium phase.
Currently, the diagnosis of early chronic pancreatitis is difficult. With future improvement in spatial resolution and with the use of secretin-enhanced pancreatography, the detection of subtle changes of the side branches may allow the earlier noninvasive diagnosis of chronic pancreatitis. Secretin-enhanced pancreatography also has the potential to depict the anatomic relationships of pancreatic ducts and pseudocysts and to aid in the evaluation of pancreatic exocrine function.
Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy. The disease has occurred in patients with moderate to end-stage renal disease after being given a gadolinium-based contrast agent to enhance MRI or MRA scans.
NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.
Degree of Confidence
Because of the introduction of faster imaging sequences and phased-array coils, the accuracy of MRCP has improved considerably, although some concern remains regarding the resolution of smaller pancreatic ducts.
Secretin-enhanced MRCP improves the detection of diseased pancreatic ducts when no abnormality can be shown in physiologic conditions. It also provides additional functional information regarding pancreatic exocrine function. As experience grows, MRI imaging, particularly MRCP, may be increasingly used in assessing and screening for chronic pancreatitis.
False Positives/Negatives
Standard good-quality protocols are important with MRCP; otherwise, poor examination technique may create false lesions, which may increase the frequency of unnecessary ERCP examinations.
Ultrasonography
Chronic pancreatitis. Transverse sonogram shows an echogenic, enlarged pancreas with multiple small hyperechoic nonshadowing foci in the pancreas (in the same patient as in Images 14-15 in Multimedia).
Chronic pancreatitis. Longitudinal sonogram through the head of the pancreas (in the same patient as in Images 13 and 15 in Multimedia) shows an echogenic pancreas with multiple, small, hyperechoic, nonshadowing foci.
Chronic pancreatitis. A 52-year-old woman known to have chronic pancreatitis (same patient as in Images 17-19 in Multimedia) presented with moderate left upper quadrant pain. Transverse sonogram through the pancreas shows a 4.37-cm pseudocyst in the tail of the pancreas (arrow).
Chronic pancreatitis. Longitudinal sonogram (in the same patient as in Images 16, 18, and 19 in Multimedia) shows a pseudocyst at the splenic hilum. Doppler sonogram (not shown) showed no signal in the splenic vein.
Findings
Ultrasonography may be useful in depicting the anatomy of pancreas (see Anatomy). Primary findings on abdominal sonography include changes in the size, shape contour, and echotexture of the pancreas. Irregular pancreatic contour is seen in 45-60% of patients, focal enlargement is detected in 12-32%, and diffuse enlargement occurs in 27-45%. Peripancreatic fascial thickening and blurring of the pancreatic margins are seen in approximately 15% of patients.11,12,13
In early disease, the pancreas may be enlarged and hypoechoic, with ductal dilatation. Later, the pancreas becomes heterogeneous, with areas of increased echogenicity and focal or diffuse enlargement. Pseudocysts may occur, and focal hypoechoic inflammatory masses may mimic pancreatic neoplasia. Calculi and calcification in the gland result in densely echogenic foci, which may show shadow. The pancreatic and common bile ducts may be dilated.
In late stages of the disease, the pancreas becomes atrophic and fibrotic, and it shrinks. These changes result in a small, echogenic pancreas with a heterogeneous echotexture. The pancreatic duct remains dilated and has a beaded appearance because of multiple stenoses. When seen, biliary dilation is mild.
Other complications, such as arterial pseudoaneurysms, left-sided portal hypertension (ie, splenic venous thrombosis), and pleural effusions are readily detected by using sonography.
Endoscopic ultrasonography (EUS) is more sensitive at showing the changes mentioned above, and the changes can be seen at an earlier stage of disease. The most characteristic EUS findings in chronic pancreatitis are parenchymal changes presenting as oval hypoechoic areas that are smaller than 1 mm and separated by hyperechoic fibrous septa.
Degree of Confidence
Although ultrasonography cannot always help in the diagnosis of chronic pancreatitis, it is a highly accurate noninvasive technique for detecting the complications of chronic pancreatitis. Ultrasonography also can help in detecting other causes of epigastric pain.
False Positives/Negatives
Sonograms may demonstrate a normal pancreas in the presence of established chronic pancreatitis. The pancreas is not always seen; it may be obscured by gas or fat. Differentiation between chronic pancreatitis and pancreatic carcinoma may be difficult and sometimes impossible.
Nuclear Imaging
Findings
FDG-PET in the Detection of Pancreatic Carcinoma in Chronic Pancreatitis
Patients with chronic pancreatitis are at risk of developing pancreatic cancer. FDG-PET has been established as a tool for the diagnosis of pancreatic carcinoma. Early detection is mandatory, as cure can only be achieved in nonadvanced disease; however, this is very difficult with conventional radiologic techniques. Van Kouwen et al investigated whether FDG-PET can detect pancreatic cancer in the setting of chronic pancreatitis.14 Their results revealed that in 67 of the 77 patients with chronic pancreatitis (87%), pancreatic FDG accumulation was absent. Of the 6 patients with pancreatic cancer complicating chronic pancreatitis, focal uptake was seen in 5 patients and minor uptake in 1 patient. FDG-PET was positive in almost all pancreatic cancer patients (used as controls). FDG-PET was negative in the large majority (87%) of patients, which suggests that a positive PET scan in chronic pancreatitis patients must lead to efforts toexclude a malignancy. These data suggest that FDG-PET has a potential role as a diagnostic tool for detecting pancreatic cancer in long-standing chronic pancreatitis. Rasmussen and associates, however, could not confirm or exclude malignancy in 25 indeterminate pancreatic head masses using FDG-PET imaging. 11C-acetate-PET provided no additional diagnostic benefits.15
FDG-PET of autoimmune- related pancreatitis: preliminary results
Nakamoto Y et al described FDG-PET findings in 6 patients with autoimmune-related pancreatitis (AIP), which is considered a reversible form of chronic pancreatitis.16,17 PET demonstrated intense uptake in the whole pancreas, which appeared swollen on CT, and the accumulation increased with time in 3 patients. In 1 patient, intense focal uptake in the pancreatic head was observed, and the accumulation decreased over time. In the remaining patient, no abnormal accumulation in the pancreas was observed. In 3 patients, follow-up PET scanning was performed after steroid therapy, and intense FDG uptake was no longer observed. The author’s preliminary data show that AIP can cause intense FDG uptake in the pancreas. This fact, along with the benign status of the condition, should be kept in mind when making a diagnosis with FDG-PET in patients with pancreatic disorders.
Degree of Confidence
In the studies note above,14,15 FDG-PET was positive in almost all pancreatic cancer patients (used as controls) and cancer complicating chronic pancreatitis. FDG-PET was negative in the large majority (87%) of chronic pancreatitis patients, which suggests that a positive PET scan in chronic pancreatitis patients must lead to efforts to exclude a malignancy.
False Positives/Negatives
Autoimmune-related pancreatitis may be a source of a positive FDG-PET.16 This fact, along with the benign status of the condition, should be kept in mind when making a diagnosis with FDG-PET in patients with pancreatic disorders.
Angiography
Chronic pancreatitis. Manually subtracted celiac-axis angiogram (in the same patient as in Images 16, 17, and 19 in Multimedia) shows stretching of the pancreaticoduodenal artery with arterial tortuosity and a capillary blush in the region of the splenic hilum. These findings are superimposed on the left kidney and suggest an inflammatory mass.
Chronic pancreatitis. Manually subtracted venous-phase celiac-axis angiogram (in the same patient as in Images 16-18 in Multimedia) shows an occluded splenic vein and a large peripancreatic collateral vein that drains into the portal vein.
Findings
Angiographic findings in pancreatitis are related to the duration and severity of disease. Vascular abnormalities are usually minimal in patients who have had the disease for less than 2 years. The tortuosity of the pancreatic vessels is increased and associated with angulation of the pancreatic arcades.
In long-standing disease, the major intrapancreatic arteries and their branches have a beaded appearance in which short dilated segments alternate with narrow segments. Long-standing chronic pancreatitis associated with patch fibrosis results in the prolonged accumulation of contrast material. With diffuse fibrosis, both the number of intrahepatic arteries and the contrast agent accumulation are decreased.
The major vessels around the pancreas may be involved. The splenic artery is particularly susceptible to pancreatitis, and a sleevelike narrowing of the artery may occur. The splenic and superior mesenteric veins may be narrowed or may have luminal irregularities. Venous compression and/or occlusion, particularly in the splenic vein, occurs in 20-50% of patients with chronic pancreatitis. Portoportal shunting and gastric varices without esophageal varices may be seen as a result of splenic vein occlusion.
Degree of Confidence
Pancreatic angiography is usually reserved for patients in whom vascular complications from chronic pancreatitis are suspected. Angiography aids in the diagnosis of pseudoaneurysms, which may be treated by means of transcatheter embolization. By using certain criteria, differentiation between chronic pancreatitis and pancreatic carcinoma is possible in some patients on the basis of angiography (see False Positives/Negatives below).
False Positives/Negatives
The sleevelike narrowing of the splenic artery that occurs in pancreatitis may appear similar to atherosclerosis. However, the splenic artery is straight and narrow in pancreatitis, whereas, in atherosclerosis, it tends to be generally tortuous and irregularly narrowed. Encasement by a carcinoma may cause a similar sleevelike narrowing, but the involved segment is usually short.
Occasionally, differentiation between chronic pancreatitis and pancreatic carcinoma can be difficult with angiography; unfortunately, this also is the case with nearly all available imaging modalities.
The major differentiating features include the following:
- The course of the pancreatic arteries remains relatively unchanged in chronic pancreatitis. In contrast, a pancreatic carcinoma invariably changes the course of the arteries, which is characterized by abrupt angulation and distortion. However, similar changes may occur in chronic pancreatitis when pancreatic fibrosis ensues.
- Changes in arterial luminal caliber in chronic pancreatitis remain relatively smooth. In contrast, a carcinoma results in irregular and jagged-appearing changes in the caliber of the lumen.
- Characteristic arterial changes in chronic pancreatitis tend to be associated with an increase in the number of arteries, whereas, in carcinoma, the overall vascularity is decreased.
- Vascular changes in chronic pancreatitis are more diffuse, and carcinomas usually cause focal changes.
More on Pancreatitis, Chronic |
| Overview: Pancreatitis, Chronic |
 Imaging: Pancreatitis, Chronic |
| Follow-up: Pancreatitis, Chronic |
| Multimedia: Pancreatitis, Chronic |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Kinney TP, Freeman ML. Approach to acute, recurrent, and chronic pancreatitis. Minn Med. Jun 2008;91(6):29-33. [Medline].
Conwell DL, Banks PA. Chronic pancreatitis. Curr Opin Gastroenterol. Sep 2008;24(5):586-90. [Medline].
Witt H, Apte MV, Keim V, Wilson JS. Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy. Gastroenterology. Apr 2007;132(4):1557-73. [Medline].
Dähnert W. Radiology Review Manual. 6th Edition. Philadelphia, Pa: Wolters Kluwer Health; 2006:741-742.
Strum WB, Spiro HM. Chronic pancreatitis. Ann Intern Med. Feb 1971;74(2):264-77. [Medline].
Lévy P, Hammel P, Ruszniewski P. [Autoimmune pancreatitis.]. Presse Med. May 7 2007;[Medline].
Perkins JD. Optical coherence tomography: Expanding use in the bile duct. Liver Transpl. Apr 24 2007;13(5):765-768. [Medline].
Kim HC, Yang DM, Kim HJ, Lee DH, Ko YT, Lim JW. Computed Tomography Appearances of Various Complications Associated with Pancreatic Pseudocysts. Acta Radiol. Apr 29 2008;1-8. [Medline].
Kim HC, Yang DM, Kim HJ, Lee DH, Ko YT, Lim JW. Computed tomography appearances of various complications associated with pancreatic pseudocysts. Acta Radiol. Sep 2008;49(7):727-34. [Medline].
Kim T, Murakami T, Takamura M, et al. Pancreatic mass due to chronic pancreatitis: correlation of CT and MR imaging features with pathologic findings. AJR Am J Roentgenol. Aug 2001;177(2):367-71. [Medline].
Catalano MF, Sahai A, Levy M, Romagnuolo J, Wiersema M, Brugge W, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. Feb 23 2009;[Medline].
Al-Haddad M, Eloubeidi MA. Diagnostic and therapeutic applications of endoscopic ultrasound-guided punctures. Dig Dis. 2008;26(4):390-7. [Medline].
Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR. EUS-Guided Celiac Plexus Neurolysis for Pain due to Chronic Pancreatitis or Pancreatic Cancer Pain: A Meta-Analysis and Systematic Review. Dig Dis Sci. Jan 10 2009;[Medline].
Van Kouwen MC, Jansen JB, van Goor H, de Castro S, Oyen WJ, Drenth JP. FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging. Apr 2005;32(4):399-404. [Medline].
Rasmussen I, Sörensen J, Långström B, Haglund U. Is positron emission tomography using 18F-fluorodeoxyglucose and 11C-acetate valuable in diagnosing indeterminate pancreatic masses?. Scand J Surg. 2004;93(3):191-7. [Medline].
Nakamoto Y, Saga T, Ishimori T, Higashi T, Mamede M, Okazaki K. FDG-PET of autoimmune-related pancreatitis: preliminary results. Eur J Nucl Med. Dec 2000;27(12):1835-8. [Medline].
Nakamoto Y, Sakahara H, Higashi T, Saga T, Sato N, Okazaki K. Autoimmune pancreatitis with F-18 fluoro-2-deoxy-D-glucose PET findings. Clin Nucl Med. Oct 1999;24(10):778-80. [Medline].
Patlas M, Deitel W, Taylor B, Gallinger S, Wilson SR. Focal chronic pancreatitis mimicking pancreatic head carcinoma: are there suggestive features on ultrasound?. Can Assoc Radiol J. Feb 2007;58(1):15-21. [Medline].
Alkim H, Gurkaynak G, Sezgin O, et al. Chronic pancreatitis and aortic pseudoaneurysm in Behcet''s disease. Am J Gastroenterol. Feb 2001;96(2):591-3. [Medline].
Bennett GL, Hann LE. Pancreatic ultrasonography. Surg Clin North Am. Apr 2001;81(2):259-81. [Medline].
Cooperman AM. Surgery and chronic pancreatitis. Surg Clin North Am. Apr 2001;81(2):431-55. [Medline].
Eerens I, Vanbeckevoort D, Vansteenbergen W, Van Hoe L. Autoimmune pancreatitis associated with primary sclerosing cholangitis: MR imaging findings. Eur Radiol. 2001;11(8):1401-4. [Medline].
Elmas N. The role of diagnostic radiology in pancreatitis. Eur J Radiol. May 2001;38(2):120-32. [Medline].
Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. Feb 2001;120(3):682-707. [Medline].
Irie H, Honda H, Kuroiwa T, et al. Measurement of the apparent diffusion coefficient in intraductal mucin- producing tumor of the pancreas by diffusion-weighted echo-planar MR imaging. Abdom Imaging. Jan 2002;27(1):82-87. [Medline].
Ito K, Koike S, Matsunaga N. MR imaging of pancreatic diseases. Eur J Radiol. May 2001;38(2):78-93. [Medline].
Megibow AJ, Lavelle MT, Rofsky NM. MR imaging of the pancreas. Surg Clin North Am. Apr 2001;81(2):307-20, ix-x. [Medline].
Prasad SR, Sahani D, Saini S. Clinical applications of magnetic resonance cholangiopancreatography. J Clin Gastroenterol. Nov-Dec 2001;33(5):362-6. [Medline].
Sakorafas GH, Farnell MB, Nagorney DM, Sarr MG. Surgical management of chronic pancreatitis at the Mayo Clinic. Surg Clin North Am. Apr 2001;81(2):457-65. [Medline].
Shams J, Stein A, Cooperman AM. Computed tomography for pancreatic diseases. Surg Clin North Am. Apr 2001;81(2):283-306. [Medline].
Takase M, Suda K. Histopathological study on mechanism and background of tumor-forming pancreatitis. Pathol Int. May 2001;51(5):349-54. [Medline].
Vlodov J, Tenner SM. Acute and chronic pancreatitis. Prim Care. Sep 2001;28(3):607-28, vii. [Medline].
Wallace MB, Hawes RH. Endoscopic ultrasound in the evaluation and treatment of chronic pancreatitis. Pancreas. Jul 2001;23(1):26-35. [Medline].
Further Reading
Related eMedicine topics
Pancreatitis Chronic (from Gastroenterology)
Pancreatitis (from Emergency Medicine)
Pancreatitis and Pancreatic Pseudocyst
Autoimmune Pancreatitis
Pancreatitis, Acute
Clinical guidelines
The Role of Endoscopy in Patients With Chronic Pancreatitis
Operative Treatment for Chronic Pancreatitis
Clinical trials
Role of Antioxidants Supplementation in Chronic Pancreatitis
The Incretin Effect in Patients With Chronic Pancreatitis
Keywords
chronic pancreatitis, pancreatitis, pancreas, chronic calcifying pancreatitis, chronic obstructive pancreatitis, chronic inflammatory pancreatitis, pancreatic dysfunction, alcoholic pancreatitis, calcific pancreatitis, obstructive pancreatitis, inflammatory pancreatitis, pancreatic pseudotumor, autoimmune pancreatitis.
