TY - JOUR
T1 - Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis
AU - Frøkjær, Jens Brøndum
AU - Akisik, Fatih
AU - Farooq, Ammad
AU - Akpinar, Burcu
AU - Dasyam, Anil
AU - Drewes, Asbjørn Mohr
AU - Haldorsen, Ingfrid S
AU - Morana, Giovanni
AU - Neoptolemos, John P
AU - Olesen, Søren Schou
AU - Petrone, Maria Chiara
AU - Sheel, Andrea
AU - Shimosoegawa, Tooru
AU - Whitcomb, David C
AU - Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis
N1 - Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.
AB - The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.
KW - Chronic pancreatitis
KW - Diagnosis
KW - Guidelines
KW - Imaging
KW - Severity
UR - http://www.scopus.com/inward/record.url?scp=85052751649&partnerID=8YFLogxK
U2 - 10.1016/j.pan.2018.08.012
DO - 10.1016/j.pan.2018.08.012
M3 - Journal article
C2 - 30177434
SN - 1424-3903
VL - 18
SP - 764
EP - 773
JO - Pancreatology
JF - Pancreatology
IS - 7
ER -