Magnetic resonance cholangiopancreatography for the diagnostic evaluation of autoimmune pancreatitis.
OBJECTIVE
The aim of this study was to determine the role of magnetic resonance cholangiopancreatography (MRCP) for diagnosing autoimmune pancreatitis (AIP) and the accuracy of MRCP in depicting the main pancreatic duct (MPD) morphology of AIP using endoscopic retrograde cholangiopancreatography (ERCP) as the reference standard.


METHODS
Thirty-eight AIP patients, 40 pancreatic cancer patients, and 40 patients with normal pancreas were included. MRCP was interpreted in association with cross-sectional magnetic resonance images regarding MPD morphology, pancreatic parenchyma, and extrapancreatic abnormalities. Main pancreatic duct was interpreted as narrowed when a narrowed-appearing segment on MRCP was associated with upstream dilatation or pancreatic parenchymal abnormalities in the same location.


RESULTS
Accuracy of MRCP for depicting MPD morphology of AIP (64.7% [22/34]) was lower than those for pancreatic cancer (88.5% [23/26]) (P = 0.041) or normal pancreas (100% [40/40]) (P < 0.0005). The inaccuracy in AIP was primarily (10/12) due to overestimation of MPD narrowing. Of various differing MRCP findings between AIP and pancreatic cancer, multiple MPD narrowing (AIP vs cancer, 27/38 vs 0/40) and upstream MPD dilatation greater than 5 mm in diameter (AIP vs cancer, 0/38 vs 10/40) could exclude pancreatic cancer and AIP, respectively.


CONCLUSIONS
MRCP cannot replace ERCP for the diagnostic evaluation of AIP but may deserve to be used when ERCP has been unsuccessful or is difficult to perform.
Park
Seong Ho
SH
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. seongho@amc.seoul.kr
Kim
Myung-Hwan
MH
Kim
So Yeon
SY
Kim
Hye Jin
HJ
Moon
Sung-Hoon
SH
Lee
Seung Soo
SS
Byun
Jae Ho
JH
Lee
Sung Koo
SK
Seo
Dong Wan
DW
Lee
Moon-Gyu
MG
D001327:Autoimmune Diseases / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003937:Diagnosis, Differential; D006801:Humans; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity