New Advances in Pancreatic Imaging
New Advances in Pancreatic Imaging
Purpose of Review: Exciting new developments and applications of imaging techniques in pancreatic diseases have emerged. This review discusses these new advances and how they are improving our ability to diagnose malignancies and inflammatory lesions, to grade severity of pancreatitis, and to stage pancreatic cancer accurately.
Recent Findings: A new computed tomography severity index shows promise for grading the severity of acute pancreatitis. Magnetic resonance imaging is comparable with computed tomography in staging acute pancreatitis. Analysis of pancreatograms and textural changes of the parenchyma may prove helpful in diagnosing chronic pancreatitis. Contrast enhanced ultrasonography may prove to be a useful way to judge the degree of inflammation and fibrosis in autoimmune pancreatitis and to monitor response to steroid therapy. The debate over the best means of staging pancreatic cancer has focused on endoscopic ultrasound and computed tomography. Preliminary studies with contrast enhanced ultrasonography report improved diagnostic and staging capabilities with pancreatic cystic and solid neoplasms. Improvements in positron emission tomography/computed tomography scans may improve the detection of neuroendocrine tumors.
Summary: These new advances will help refine the diagnosis and staging of pancreatic diseases.
The mainstays of imaging for pancreatic disease have been computed tomography, magnetic resonance imaging (MRI), endoscopic retrograde pancreatography, and endoscopic ultrasound (EUS). Recently, there have been new advancements and refinements in all of these techniques, resulting in improved imaging of the pancreas. The computed tomography scan of choice is now the multidetector-row computed tomography (MDCT), which allows faster image acquisition and improved resolution (Fig. 1). Furthermore, these improved detailed images can be converted into three-dimensional reconstructions. MRI with gadolinium can also provide detailed images including three-dimensional pancreatograms (MRCPs) and is now the MRI modality of choice (Fig. 2). Pancreas-specific contrast agents, namely mangafodipir, have also improved the image quality of pancreatic lesions.
(Enlarge Image)
Multidetector computed tomography with reconstruction along the course of the main pancreatic duct. The patient had a diffusely dilated pancreatic duct as a result of an ampullary malignancy.
(Enlarge Image)
Magnetic resonance cholangiopancreatography of the pancreas demonstrated ductal changes of chronic pancreatitis. A stricture in main pancreatic duct is shown (arrow).
New ultrasound techniques have also been applied to imaging of the pancreas. Contrast-enhanced ultrasound is gaining influence in Europe and Asia. This technique utilizes the combination of microbubbles of gas that enhance the echogenicity of blood flow and tissue harmonic imaging that uses an ultrasound frequency twice as high as standard ultrasound to improve the assessment of vascularity of lesions. PET/computed tomography scans, which allow image fusion from both individual modalities, have improved tumor identification. Other metabolites are being investigated for their usefulness in nuclear medicine scans.
This review discusses recent applications of these new techniques as well as new applications of older techniques to various pancreatic diseases, including acute and chronic pancreatitis, pancreatic adenocarcinoma, cystic neoplasms, and neuroendocrine tumors, and their implications for clinical practice.
Purpose of Review: Exciting new developments and applications of imaging techniques in pancreatic diseases have emerged. This review discusses these new advances and how they are improving our ability to diagnose malignancies and inflammatory lesions, to grade severity of pancreatitis, and to stage pancreatic cancer accurately.
Recent Findings: A new computed tomography severity index shows promise for grading the severity of acute pancreatitis. Magnetic resonance imaging is comparable with computed tomography in staging acute pancreatitis. Analysis of pancreatograms and textural changes of the parenchyma may prove helpful in diagnosing chronic pancreatitis. Contrast enhanced ultrasonography may prove to be a useful way to judge the degree of inflammation and fibrosis in autoimmune pancreatitis and to monitor response to steroid therapy. The debate over the best means of staging pancreatic cancer has focused on endoscopic ultrasound and computed tomography. Preliminary studies with contrast enhanced ultrasonography report improved diagnostic and staging capabilities with pancreatic cystic and solid neoplasms. Improvements in positron emission tomography/computed tomography scans may improve the detection of neuroendocrine tumors.
Summary: These new advances will help refine the diagnosis and staging of pancreatic diseases.
The mainstays of imaging for pancreatic disease have been computed tomography, magnetic resonance imaging (MRI), endoscopic retrograde pancreatography, and endoscopic ultrasound (EUS). Recently, there have been new advancements and refinements in all of these techniques, resulting in improved imaging of the pancreas. The computed tomography scan of choice is now the multidetector-row computed tomography (MDCT), which allows faster image acquisition and improved resolution (Fig. 1). Furthermore, these improved detailed images can be converted into three-dimensional reconstructions. MRI with gadolinium can also provide detailed images including three-dimensional pancreatograms (MRCPs) and is now the MRI modality of choice (Fig. 2). Pancreas-specific contrast agents, namely mangafodipir, have also improved the image quality of pancreatic lesions.
(Enlarge Image)
Multidetector computed tomography with reconstruction along the course of the main pancreatic duct. The patient had a diffusely dilated pancreatic duct as a result of an ampullary malignancy.
(Enlarge Image)
Magnetic resonance cholangiopancreatography of the pancreas demonstrated ductal changes of chronic pancreatitis. A stricture in main pancreatic duct is shown (arrow).
New ultrasound techniques have also been applied to imaging of the pancreas. Contrast-enhanced ultrasound is gaining influence in Europe and Asia. This technique utilizes the combination of microbubbles of gas that enhance the echogenicity of blood flow and tissue harmonic imaging that uses an ultrasound frequency twice as high as standard ultrasound to improve the assessment of vascularity of lesions. PET/computed tomography scans, which allow image fusion from both individual modalities, have improved tumor identification. Other metabolites are being investigated for their usefulness in nuclear medicine scans.
This review discusses recent applications of these new techniques as well as new applications of older techniques to various pancreatic diseases, including acute and chronic pancreatitis, pancreatic adenocarcinoma, cystic neoplasms, and neuroendocrine tumors, and their implications for clinical practice.
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