title: Pancreatic fluid collections: What is the ideal imaging technique?
abstract: Pancreatic fluid collections (PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walled-off necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging (MRI) performs better than computed tomography (CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis (seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis (solid debris delineation) and management (drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with (18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Narendra
authors.initials: N
authors.lastname: Dhaka
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Jayanta
authors.initials: J
authors.lastname: Samanta
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Kochhar
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Navin
authors.initials: N
authors.lastname: Kalra
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Sreekanth
authors.initials: S
authors.lastname: Appasani
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Manrai
authors.affiliation: Narendra Dhaka, Jayanta Samanta, Sreekanth Appasani, Rakesh Kochhar, Manish Manrai, Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160020, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kochhar
mesh_terms: D000208:Acute Disease; D049448:Cholangiopancreatography, Magnetic Resonance; D003952:Diagnostic Imaging / Q000379:methods*; D004322:Drainage / Q000295:instrumentation; D019160:Endosonography; D006801:Humans; D064847:Multimodal Imaging; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010181:Pancreatic Cyst / Q000175:diagnosis* / Q000628:therapy; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000628:therapy; D010195:Pancreatitis / Q000175:diagnosis* / Q000628:therapy; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: Acute necrotic collections; Acute pancreatitis; Acute peripancreatic fluid collections; Contrast-enhanced computed tomography; Endoscopic ultrasound; Magnetic resonance imaging; Pancreatic fluid collections; Positron emission tomography scan; Pseudocysts; Walled-off necrosis