MRI and MRCP in acute edematous interstitial pancreatitis Poster No.: C-0212 Congress: ECR 2010 Type: Scientific Exhibit Topic: Abdominal Viscera (Solid Organs) - Pancreas Authors: M. Di Girolamo, A. Grossi, G. Fabbri, M. Pietravalle, M. Citone, V. David; Rome/IT Keywords: MR-cholangio-pancreatography (MRCP), pancreas, acute edematous interstitial pancreatitis Keywords: Abdomen, Pancreas DOI: 10.1594/ecr2010/C-0212 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 27
Purpose To evaluate with MRI and MRCP patients with acute edematous interstitial pancreatitis. Page 2 of 27
Methods and Materials 17 patients with acute edematous interstitial pancreatitis -diagnosed on the basis of the increased serum values of alpha-amylase and lipase -preliminary undergone multislice-ct (MSCT) 1.5 T superconductive unit (Philips Medical System): -non-breath holding TSE T2-weighted axial scans (TR: 2300 ms, TE: 100 ms; ETL: 24, acq. time: 1' 24") in 12 patients -single shot non-breath holding TSE T2-weighted axial scans (TR: 785 ms; TE: 60; ETL:86; NSA: 1; Echo spacing: minimum; acq. time: 19 s) in 5 patients MR-cholangiopancreatography: -3D fat-suppressed breath-holding TSE T2-weighted scans on coronal planes (TR: 8000 ms; TE: 320 ms; ETL: 128; sl. thick.: 3 mm; acq. time: 18 s) -3D row images were post-processed with MIP algorithm Page 3 of 27
Results The entire MR examination lasted no longer than 10 minutes for each patient. The images obtained were always diagnostically acceptable. In 9 patients (53%): -diffuse pancreatic enlargment due to parenchymal edema (Fig. 1-2): Fig.: FIG.1-TSE T2 W References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 4 of 27
Fig.: FIG.2 TSE T2-w References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT in 2 patients (18%): - thickening of retroperitoneal fascial planes (pre-renal e latero-conal fascia); in 1 patient: - small fluid effusion at the level of the epiploon cavity(fig 3): Page 5 of 27
Fig.: FIG.3 TSE T2-w References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Axial single shot TSE scans allow a better detection of MBD stones in comparison with axial TSE T2-weighted scans (Fig 4-5): Page 6 of 27
Fig.: FIG.4 TSE T2-w. References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 7 of 27
Fig.: FIG.5 Single-Shot TSE References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT MR-cholangiopancreatography: -in 6 patients (35%): - choledocholithiasis: - multiple stones in 5 pts(fig 6-7) ; - single stone in 1 pt (Fig 8-9). In only 4 of the 6 cases MSCT detected MBD stones -in 1 patient: - "pancreas divisum" Page 8 of 27
Fig.: FIG.6 Multiple stones in MBD References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 9 of 27
Fig.: FIG.7 MIP rec. images that show multiple stones in MBD References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 10 of 27
Fig.: FIG.8 3D scans, Single stone in MBD References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 11 of 27
Fig.: FIG.9 MIP rec. images,single stone in MBD References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT MR-cholangiopancreatography: - in 2 patients (24%): dilation of MBD without stones due to edema of pancreatic parenchyma (Fig 10-11-12) Page 12 of 27
Fig.: FIG.10 TSE T2-w. References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 13 of 27
Fig.: FIG.11 3D scan showing dilation of MBD without stones References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 14 of 27
Fig.: FIG.12 MIP rec. images References: Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 15 of 27
Images for this section: Fig. 0: FIG.1-TSE T2 W Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 16 of 27
Fig. 0: FIG.3 TSE T2-w Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 17 of 27
Fig. 0: FIG.4 TSE T2-w. Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 18 of 27
Fig. 0: FIG.5 Single-Shot TSE Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 19 of 27
Fig. 0 Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 20 of 27
Fig. 0: FIG.9 MIP rec. images,single stone in MBD Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 21 of 27
Fig. 0: FIG.7 MIP rec. images that show multiple stones in MBD Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 22 of 27
Fig. 0: FIG.10 TSE T2-w. Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 23 of 27
Fig. 0: FIG.11 3D scan showing dilation of MBD without stones Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 24 of 27
Fig. 0: FIG.12 MIP rec. images Dept. of Radiology, Sant'Andrea Hospital - Rome/IT Page 25 of 27
Conclusion In acute pancreatitis MRI with ultra-fast imaging in less than 10 minutes provides valuable information about the status of the pancreatic parenchyma and allows detection of MBD stones. MRCP is considered the most sensitive non-invasive diagnostic imaging technique in the detection of choledocholithiasis. MRI with MRCP should be performed in cases of acute pancreatitis in order to detect MBD stones and to perform ERCP with papillotomy within the first 24 hours from the onset of symptoms. Page 26 of 27
References - Kenneth M. Vitellas, Mary T. Keogan, Charles E. Spritzer, and Rendon C. Nelson: MR Cholangiopancreatography of Bile and Pancreatic Duct Abnormalities with Emphasis on the Single-Shot Fast Spin-Echo Technique Radiographics July 2000 20:939-957; - Hiroyuki Irie, Hiroshi Honda, Toshiro Kuroiwa, Kengo Yoshimitsu, Hitoshi Aibe, Kenji Shinozaki, and Kouji Masuda: Pitfalls in MR Cholangiopancreatographic Interpretation Radiographics January 2001 21:23-37. Page 27 of 27