Morphological and functional evaluation of chronic pancreatitis with magnetic resonance imaging

Abstract

Magnetic resonance imaging (MRI) techniques for assessment of morphology and function of the pancreas have been improved dramatically the recent years and MRI is very often used in diagnosing and follow-up of chronic pancreatitis (CP) patients. Standard MRI including fat-suppressed T1-weighted and T2-weighted imaging techniques reveal decreased signal and glandular atrophy of the pancreas in CP. In contrast-enhanced MRI of the pancreas in CP the pancreatic signal is usually reduced and delayed due to decreased perfusion as a result of chronic inflammation and fibrosis. Thus, morphological changes of the ductal system can be assessed by magnetic resonance cholangiopancreatography (MRCP). Furthermore, secretin-stimulated MRCP is a valuable technique to evaluate side branch pathology and the exocrine function of the pancreas and diffusion weighted imaging can be used to quantify both parenchymal fibrotic changes and the exocrine function of the pancreas. These standard and advanced MRI techniques are supplementary techniques to reveal morphological and functional changes of the pancreas in CP. Recently, spectroscopy has been used for assessment of metabolite concentrations in-vivo in different tissues and may have the potential to offer better tissue characterization of the pancreas. Hence, the purpose of the present review is to provide an update on standard and advanced MRI techniques of the pancreas in CP.

Keywords: Chronic pancreatitis; Diffusion weighted imaging; Exocrine pancreatic function; Magnetic resonance; Secretin.

Figure 1

Pancreatic morphology. Axial T2-weighted magnetic resonance imaging views showing glandular atrophy (A), dilated irregular duct (B, arrow) and irregular side-branches (C, arrow heads) in a patient with chronic pancreatitis.

Figure 2

Magnetic resonance cholangiopancreatography. Upper figure displays a single coronal image and the lower figure a 3D view of the pancreato-biliary tree. In this chronic pancreatitis patient the dilated irregular main duct has irregular side branches (arrow heads) and contains multiple rounded filling defects (arrows).

Figure 3

Diffusion weighted imaging. The apparent diffusion coefficient map of a chronic pancreatitis patient is shown with a measuring region of interest positioned in the pancreatic head to assess the degree of parenchymal fibrosis (red is high and blue low water diffusion).