Visualization of the heterogeneous internal structure of so-called "pancreatic necrosis" by magnetic resonance imaging in acute necrotizing pancreatitis.
BACKGROUND
Contrast-enhanced computed tomography (CT) is the gold standard for assessing the severity of acute pancreatitis, especially for evaluating the presence of pancreatic necrosis (poorly perfused area). However, the contrast medium used for CT is potentially toxic to the pancreas and kidney. Therefore, medical institutions without facilities for hemodialysis hesitate to acquire contrast-enhanced CT images. Diagnostic values of magnetic resonance imaging (MRI) in pancreatic diseases have been shown.


OBJECTIVE
To evaluate the usefulness of MRI in the assessment of the severity of acute pancreatitis.


RESULTS
All necrotic regions in the pancreas were visualized by gadolinium-enhanced MRI. Furthermore, MRI can discriminate the poorly perfused pancreatic area, namely so-called "pancreatic necrosis" judged on CT, into three parts: 1) necrotic area of the pancreatic parenchyma, 2) perinecrotic fluid collection, and 3) hemorrhagic foci. Inflammatory changes that were required for severity grading were also evaluated sufficiently by MRI.


CONCLUSIONS
These results suggest that MRI is useful for the assessment of severity of acute pancreatitis.
Departments of Surgery II, Kumamoto University Medical School, Kumamoto, Japan.
Masahiko
M
Hirota
Yu
Y
Kimura
Takatoshi
T
Ishiko
Toru
T
Beppu
Yasuyuki
Y
Yamashita
Michio
M
Ogawa
D000328:Adult; D000368:Aged; D001826:Body Fluids; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D019283:Pancreatitis, Acute Necrotizing / Q000473:pathology*; D014057:Tomography, X-Ray Computed