Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis

for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.

Original languageEnglish (US)
JournalPancreatology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Chronic Pancreatitis
Guidelines
Tomography
Secretin
Magnetic Resonance Imaging
Compliance
Fibrosis
Pathology

Keywords

  • Chronic pancreatitis
  • Diagnosis
  • Guidelines
  • Imaging
  • Severity

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Gastroenterology

Cite this

for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis (Accepted/In press). Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology. https://doi.org/10.1016/j.pan.2018.08.012

Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. / for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis.

In: Pancreatology, 01.01.2018.

Research output: Contribution to journalArticle

for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis 2018, 'Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis', Pancreatology. https://doi.org/10.1016/j.pan.2018.08.012
for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology. 2018 Jan 1. https://doi.org/10.1016/j.pan.2018.08.012
for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis. / Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. In: Pancreatology. 2018.
@article{55797d51f57144759de521e02847c1a1,
title = "Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis",
abstract = "The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.",
keywords = "Chronic pancreatitis, Diagnosis, Guidelines, Imaging, Severity",
author = "{for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis} and Fr{\o}kj{\ae}r, {Jens Br{\o}ndum} and M. Akisik and Ammad Farooq and Burcu Akpinar and Anil Dasyam and Drewes, {Asbj{\o}rn Mohr} and Haldorsen, {Ingfrid S.} and Giovanni Morana and Neoptolemos, {John P.} and Olesen, {S{\o}ren Schou} and Petrone, {Maria Chiara} and Andrea Sheel and Tooru Shimosoegawa and Whitcomb, {David C.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.pan.2018.08.012",
language = "English (US)",
journal = "Pancreatology",
issn = "1424-3903",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis

AU - for the Working group for the International (IAP – APA – JPS – EPC) Consensus Guidelines for Chronic Pancreatitis

AU - Frøkjær, Jens Brøndum

AU - Akisik, M.

AU - Farooq, Ammad

AU - Akpinar, Burcu

AU - Dasyam, Anil

AU - Drewes, Asbjørn Mohr

AU - Haldorsen, Ingfrid S.

AU - Morana, Giovanni

AU - Neoptolemos, John P.

AU - Olesen, Søren Schou

AU - Petrone, Maria Chiara

AU - Sheel, Andrea

AU - Shimosoegawa, Tooru

AU - Whitcomb, David C.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.

AB - The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. The following consensus was obtained: Computed tomography (CT) is often the most appropriate initial imaging modality for evaluation of patients with suspected chronic pancreatitis (CP) depicting most changes in pancreatic morphology. CT is also indicated to exclude other potential intraabdominal pathologies presenting with symptoms similar to CP. However, CT cannot exclude a diagnosis of CP nor can it be used to exclusively diagnose early or mild disease. Here magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) is superior and is indicated especially in patients where no specific pathological changes are seen on CT. Secretin-stimulated MRCP is more accurate than standard MRCP in the depiction of subtle ductal changes. It should be performed after a negative MRCP, when there is still clinical suspicion of CP. Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of the disease. No validated radiological severity scoring systems for CP are available, although a modified Cambridge Classification has been used for MRCP. There is an unmet need for development of a new and validated radiological CP severity scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications and parenchymal fibrosis based on CT and/or MRI. Secretin-stimulated MRCP in addition, can provide assessment of exocrine function and ductal compliance. An algorithm is presented, where these imaging parameters can be incorporated together with clinical findings in the classification and severity grading of CP.

KW - Chronic pancreatitis

KW - Diagnosis

KW - Guidelines

KW - Imaging

KW - Severity

UR - http://www.scopus.com/inward/record.url?scp=85052751649&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052751649&partnerID=8YFLogxK

U2 - 10.1016/j.pan.2018.08.012

DO - 10.1016/j.pan.2018.08.012

M3 - Article

JO - Pancreatology

JF - Pancreatology

SN - 1424-3903

ER -