title: Pancreatic duct changes are not associated with early signs of chronic pancreatitis at magnetic resonance imaging (MRI) in patients with primary sclerosing cholangitis.
abstract: OBJECTIVE
  The association between chronic pancreatitis (CP) and primary sclerosing cholangitis (PSC) has been reported previously. The aims of the present study were to evaluate the presence of early pancreatic abnormalities and duct changes, using MRCP/MRI in PSC and to evaluate possible risk factors for these changes and their clinical importance.
  
  
  METHODS
  One hundred and three patients with PSC were identified among all MRI liver/pancreas referrals in 2001-2005. MRCP was used to grade pancreatic duct changes in three groups: grade 0 (normal), grade 1 (mild) and grade 2 (severe). For detection of early MRI signs of CP, the pancreas-spleen signal intensity ratio (SIR), the arterial and early venous phase ratio (A/PV ratio) and the age-related size of the pancreas were evaluated.
  
  
  RESULTS
  Pancreatic duct changes were found in 24% of the PSC patients. The pancreatic duct changes were associated with extrahepatic biliary involvement and long duration of PSC but not associated with pancreas-spleen SIR, A/PV ratio, pancreas size, previous post-ERCP or acute pancreatitis. Severe pancreatic duct changes were significantly associated to abdominal pain. Clinically significant CP was seen in one PSC patient (1%).
  
  
  CONCLUSIONS
  Pancreatic duct changes are associated with extrahepatic bile duct strictures and not with the early MRI signs of CP. Therefore, pancreatic duct changes seem to be part of the spectrum of PSC and should not be defined as CP. Pancreatic duct changes are of limited clinical importance but may contribute to abdominal pain in PSC.
authors.affiliation: Division of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. karouk.said@ki.se
authors.forename: Karouk
authors.initials: K
authors.lastname: Said
authors.forename: Nils
authors.initials: N
authors.lastname: Albiin
authors.forename: Bo
authors.initials: B
authors.lastname: Lindberg
authors.forename: Torkel B
authors.initials: TB
authors.lastname: Brismar
authors.forename: Azza
authors.initials: A
authors.lastname: Karrar
authors.forename: Johan
authors.initials: J
authors.lastname: Permert
authors.forename: Annika
authors.initials: A
authors.lastname: Bergquist
mesh_terms: D015209:Cholangitis, Sclerosing / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000473:pathology*