title: Determination of steroid response by abdominal ultrasound in cases with autoimmune pancreatitis.
abstract: BACKGROUND
  Abdominal ultrasound is the most convenient modality for examining the morphology of the pancreas without physical stress. Steroid response is one of the key features of autoimmune pancreatitis; however, visualizing this response has not been evaluated using ultrasonography.
  
  
  METHODS
  Thirty-three consecutive autoimmune pancreatitis cases were retrospectively investigated for pancreatic and extrapancreatic lesions by ultrasonography before steroid therapy (n=33) and at two weeks (n=28) and one month (n=19) after starting oral steroid treatment.
  
  
  RESULTS
  Steroid treatment resulted in obvious shrinkage of the pancreatic lesion in 86% of the cases at two weeks and in 97% until one month. The maximum thickness of the pancreatic lesion was reduced from 28 to 22 mm in two weeks (P<0.0001), and pancreatic echographic findings improved in one month. Swelling of the peripancreatic lymph node was recognized in 48% and the aortic wall thickness in 12%, mostly reduced in two weeks (P=0.005). One case of definitive autoimmune pancreatitis revealed a steroid response only by following endoscopic retrograde cholangiopancreatography but not by ultrasonography or computed tomography.
  
  
  CONCLUSIONS
  Abdominal ultrasound revealed a steroid response in most cases of autoimmune pancreatitis within two weeks. Ultrasonography is suitable for initial confirmation of a steroid response; however, atypical cases showing insufficient response or not fulfilling criteria should undergo further examination.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. Electronic address: h.matsubayashi@scchr.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Yoneyama
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Nanri
authors.forename: Shinya
authors.initials: S
authors.lastname: Sugimoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shinjo
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Sayo
authors.initials: S
authors.lastname: Ito
authors.forename: Madoka
authors.initials: M
authors.lastname: Takao
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D001327:Autoimmune Diseases / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D012189:Retrospective Studies; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D007074:Immunoglobulin G; D013256:Steroids
keywords: Autoimmune pancreatitis; Diagnosis; IgG; Steroid response; Ultrasonography