[Pancreas. Part I: congenital changes, acute and chronic pancreatitis].
The pancreas develops from ventral and the dorsal buds, which undergo fusion. Failure to fuse results in pancreas divisum, which is defined by separate pancreatic ductal systems draining into the duodenum. Risk of developing pancreatitis is increased in pancreas divisum because of insufficient drainage. MR cholangiopancreatography (MRCP) is the technique of choice for detecting pancreas divisum non-invasively. Annular pancreas is the result of incomplete rotation of the pancreatic bud around the duodenum with the persistence of parenchyma or a fibrous band encircling (and sometimes stenosing) the duodenum. Acute pancreatitis is usually caused by bile duct stones or alcohol abuse. The Atlanta classification differentiates between mild acute and severe acute pancreatitis associated with organ failure and/or local complications such as necrosis, abscess or pseudocyst. Contrast-enhanced multi-detector row CT is the method of choice to assess the extent of disease. Balthazar et al.'s CT severity index assesses the risk of mortality and morbidity. In acute pancreatitis, the role of MRCP is mainly limited to finding bile duct stones in patients with suspected biliary pancreatitis. Chronic pancreatitis results in relentless and irreversible loss of exocrine (and sometimes endocrine) function of the pancreas. MDCT even shows subtle calcifications. MRCP is the method of choice for non-invasive assessment of the duct. Inflammatory pseudotumor in chronic pancreatitis and groove pancreatitis are difficult to differentiate from pancreatic cancer. In these cases, multiple imaging methods such as MDCT, MRI and endosonography including biopsy may be used to make a diagnosis.
Schima
W
W
Universitätsklinik für Radiodiagnostik, Medizinische Universität Wien, Osterreich. wolfgang.schima@meduniwien.ac.at
Ba-Ssalamah
A
A
Plank
C
C
Kulinna-Cosentini
C
C
Püspök
A
A
D000208:Acute Disease; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D010195:Pancreatitis / Q000151:congenital* / Q000175:diagnosis*; D050500:Pancreatitis, Chronic; D017410:Practice Guidelines as Topic; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media