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Review
. 2019 Apr;8(2):123-132.
doi: 10.21037/gs.2018.12.07.

Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis

Emanuele Grassedonio  1 , Patrizia Toia  1 , Ludovico La Grutta  1 , Stefano Palmucci  2 , Tommaso Smeraldi  1 , Giuseppe Cutaia  1 , Domenico Albano  3 , Federico Midiri  1 , Massimo Galia  1 , Massimo Midiri  1
Affiliations
Review

Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis

Emanuele Grassedonio et al. Gland Surg. 2019 Apr.

Abstract

Acute pancreatitis (AP) represents a pancreas inflammation of sudden onset that can present different degrees of severity. AP is a frequent cause of acute abdomen and its complications are still a cause of death. Biliary calculosis and alcohol abuse are the most frequent cause of AP. Computed tomography (CT) and magnetic resonance imaging (MRI) are not necessary for the diagnosis of AP but they are fundamental tools for the identification of the cause, degree severity and AP complications. AP severity assessment is in fact one of the most important issue in disease management. Contrast-enhanced CT is preferred in the emergency setting and is considered the gold standard in patients with AP. MRI is comparable to CT for the diagnosis of AP but requires much more time so it is not usually chosen in the emergency scenario. Complications of AP can be distinguished in localized and generalized. Among the localized complications, we can identify: acute peripancreatic fluid collections (APFC), pseudocysts, acute necrotic collections (ANC), walled off pancreatic necrosis (WOPN), venous thrombosis, pseudoaneurysms and haemorrhage. Multiple organ failure syndrome (MOFS) and sepsis are possible generalized complications of AP. In this review, we focus on CT and MRI findings in local complications of AP and when and how to perform CT and MRI. We paid also attention to recent developments in diagnostic classification of AP complications.

Keywords: Acute pancreatitis (AP); computed tomography (CT); magnetic resonance imaging (MRI).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
IEP in unenhanced phase (A), parenchymal phase (B) and portal phase (C). IEP, interstitial edematous pancreatitis.
Figure 2
Figure 2
IEP (arrows) red arrows indicate signal restriction at the body-tail of the pancreas in DWI image (b800, A) and ADC map (B). IEP, interstitial edematous pancreatitis. DWI, diffusion weighted imaging; ADC, apparent diffusion coefficient.
Figure 3
Figure 3
Necrotizing pancreatitis in unenhanced phase (A), parenchymal phase (B) and in portal phase (C).
Figure 4
Figure 4
APFC CT examination in unenhanced phase (A), parenchymal phase (B) and in portal phase (C); red arrows showing APFC. CT, computed tomography; APFC, acute peripancreatic fluid collections.
Figure 5
Figure 5
APFC in unenhanced axial magnetic resonance T2-w images with (A,C) and without (B) fat-suppression. Red arrows showing peripancreatic fluid collections. T2-w, T2-weighted; APFC, acute peripancreatic fluid collections.
Figure 6
Figure 6
Pseudocyst: red arrows indicate pseudocyst in unenhanced (A) and in enhanced portal phase (B) CT examination. CT, computed tomography.
Figure 7
Figure 7
Pseudocyst (red arrows) in unenhanced coronal and axial magnetic resonance T2-w images with (A) and without (B) fat suppression. T2-w, T2-weighted.
Figure 8
Figure 8
ANC (arrows) in unenhanced phase (A), parenchymal phase (B) and portal phase (C). ANC, acute necrotic collections.
Figure 9
Figure 9
ANC in unenhanced T1-w fat-sat coronal (A) and axial (B) images with evidence of haemorrhagic collection (red arrows). ANC, acute necrotic collections; T1-w, T1-weighted.
Figure 10
Figure 10
ANC with necrosis of peripancreatic fat tissue (arrow) in unenhanced axial magnetic resonance T2-w image with fat suppression. ANC, acute necrotic collections; T2-w, T2-weighted.
Figure 11
Figure 11
WOPN in unenhanced phase (A) parenchymal phase (B) portal phase (C) CT examination (red arrows). WOPN, walled off pancreatic necrosis; CT, computed tomography.
Figure 12
Figure 12
Haemorrhage on CT examination (red arrows): in unenhanced phase (A), parenchymal phase (B), portal phase (C) and in delayed phase (D).
See this image and copyright information in PMC

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