Chronic pancreatitis: Pain and computed tomography/magnetic resonance imaging findings

Abstract

Chronic pancreatitis (CP) is a fibroinflammatory disease characterized by irreversible destruction of pancreatic tissue. With the development of the disease, it may lead to exocrine and/or endocrine insufficiency. CP is one of the common diseases that cause abdominal pain, which will not get permanent spontaneous relief as the disease evolves. The American College of Gastroenterology clinical guidelines recommend computed tomography or magnetic resonance imaging as the first-line examination for the diagnosis of CP. CP common imaging findings include pancreatic atrophy, irregular dilatation of the pancreatic duct, calcification of pancreatic parenchyma, pancreatic duct stones, etc. In clinical practice, whether any correlations between CP-induced abdominal pain patterns (no pain/constant/intermittent pain) and corresponding imaging findings present are not well known. Therefore, this review aims to comprehensively sort out and analyze the relevant information by collecting lots of literature on this field, so as to construct a cross-bridge between the clinical manifestations and imaging manifestations of CP patients. Also, it provides an imaging basis and foundation for the classification and diagnosis of abdominal pain types in clinical CP patients.

Keywords: Abdominal pain; Chronic pancreatitis; Computed tomography; Magnetic resonance imaging; Pancreatitis.

Figure 1

Chronic pancreatitis. A: Chronic pancreatitis with main pancreatic duct stone and main pancreatic duct dilatation. A 58-year-old man with chronic pancreatitis presented with no pain. The abdominal computed tomography (CT) scan represents the main pancreatic duct stone (orange arrow), the dilated main pancreatic duct (yellow arrows) with a diameter of 0.5 cm, as well as the combined gallbladder multiple stones (white arrow); B: Chronic pancreatitis with pancreatic parenchymal atrophy and multiple pancreatic calcifications. A 69-year-old man with chronic pancreatitis. The abdominal CT scan shows a decrease in pancreatic volume, parenchymal atrophy, and multiple calcifications in the pancreatic parenchyma (orange arrows).

Figure 2

Chronic pancreatitis with large pancreatic cysts. A 52-year-old woman with chronic pancreatitis presented with upper abdominal pain. The upper abdominal magnetic resonance images. A: Magnetic resonance imaging (MRI) fat-suppressed T1-weighted imaging shows a large pseudocyst of the head of the pancreas, which has a low signal; B: MRI T2-weighted imaging can show a clear boundary of pseudocyst (orange arrows) with a diameter of 7 cm × 11 cm, which has a high signal; C: MRI fat-suppressed T2-weighted imaging; D: MRI enhanced scanning venous phase shows the large pseudocyst has no enhancement as well as the displaced main pancreatic duct (yellow arrows). P: Pancreas.