Abstract
Background
It is of utmost importance that autoimmune pancreatitis (AIP) be differentiated from pancreatic cancer. Irregular narrowing of the main pancreatic duct is a characteristic finding in AIP; it is useful for differentiating AIP from pancreatic cancer stenosis. This study evaluated the usefulness of magnetic resonance cholangiopancreatography (MRCP) for the diagnosis of AIP and assessed whether MRCP could replace endoscopic retrograde cholangiopancreatography (ERCP) for diagnosing AIP.
Methods
The MRCP and ERCP findings of 20 AIP patients were compared.
Results
On MRCP, the narrowed portion of the main pancreatic duct was not visualized, while the noninvolved segments of the pancreatic duct were visualized. The degree of upstream dilatation of the proximal main pancreatic duct was milder in AIP than in pancreatic cancer patients. In the skipped type, only skipped narrowed lesions were not visualized. After steroid therapy for AIP, the nonvisualized main pancreatic duct became visualized.
Conclusions
MRCP cannot replace ERCP for the diagnosis of AIP, since narrowing of the main pancreatic duct in AIP was not visualized on MRCP. MRCP findings of segmental or skipped nonvisualized main pancreatic duct accompanied by a less dilated upstream main pancreatic duct may suggest the presence of AIP. MRCP is useful for following AIP patients.
Similar content being viewed by others
References
Yoshida K, Toki F, Takeuchi T, et al. (1995) Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 40:1561–1568
Kamisawa T, Okamoto A (2006) Autoimmune pancreatitis: proposal of IgG4-related sclerosing disease. J Gastroenterol 41:613–625
Okazaki K, Kawa S, Kamisawa T, et al., Research Committee of Intractable Diseases of the Pancreas (2006) Clinical diagnostic criteria of autoimmune pancreatitis: revised proposal. J Gastroenterol 41:626–631
Sica GT, Braver J, Cooney MJ, et al. (1999) Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis. Radiology 210:605–610
Kamisawa T, Tu Y, Egawa N, et al. (2006) MRCP of congenital pancreaticobiliary malformation. Abdom Imaging. doi: 10.1007/s00261-006-9005-3, Epub ahead of print
Kamisawa T, Chen PY, Tu Y, et al. (2006) MRCP and MRI findings in 9 patients with autoimmune pancreatitis. World J Gastroenterol 12:2919–2922
Kamisawa T, Egawa N, Nakajima H, et al. (2003) Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2694–2699
Hardacre JM, Iacobuzio-Donahue CA, Sohn TA, et al. (2003) Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Ann Surg 237:853–859
Kim KP, Kim MH, Kim JC, et al. (2006) Diagnostic criteria for autoimmune chronic pancreatitis revised. World J Gastroenterol 12:2487–2496
Freeny P, Bilbao M, Katon R (1976) Blind evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: the “double duct” and other signs. Radiology 119:271–274
Menges M, Lerch MM, Zeitz M (2000) The double duct sign in patients with malignant and benign pancreatic lesions. Gastrointest Endosc 52:74–77
Acknowledgment
This study was supported by Research for Intractable Disease of the Pancreas, Minister of Labor and Welfare of Japan.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kamisawa, T., Tu, Y., Egawa, N. et al. Can MRCP replace ERCP for the diagnosis of autoimmune pancreatitis?. Abdom Imaging 34, 381–384 (2009). https://doi.org/10.1007/s00261-008-9401-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-008-9401-y