Autoimmune pancreatitis: Imaging features

Dushyant V. Sahani, Sanjeeva P. Kalva, James Farrell, Michael M. Maher, Sanjay Saini, Peter R. Myeller, Gregory Y. Lauwers, Carlos D. Fernandez, Andrew L. Warshaw, Joseph F. Simeone

Research output: Contribution to journalArticle

331 Citations (Scopus)

Abstract

PURPOSE: To retrospectively determine imaging findings in patients with autoimmune pancreatitis. MATERIALS AND METHODS: Twenty-nine patients (25 male and four female; mean age, 56 years; range, 15-82 years) with histopathologic diagnosis of autoimmune pancreatitis were examined. Data were reviewed by two radiologists in consensus. Imaging findings for review included those from helical computed tomography (CT), 25 patients; magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP), four patients; endoscopic ultrasonography (US), 21 patients; endoscopic retrograde cholangiopancreatography (ERCP), 19 patients; and percutaneous transhepatic cholangiography, one patient. Images were analyzed for appearances of pancreas, biliary and pancreatic ducts, and other findings, such as peripancreatic inflammation, encasement of vessels, mass effect, pancreatic calcification, peripancreatic nodes, and peripancreatic fluid collection. Follow-up images were available in nine patients. Serologic markers such as serum immunoglobulin G (IgG) and antinuclear antibody levels were available in 12 patients. RESULTS: CT showed diffuse (n = 14) and focal (n = 7) enlargement of pancreas. Seven patients had minimal peripancreatic stranding, with lack of vascular encasement, calcification, or peripancreatic fluid collection. Nine patients had enlarged peripancreatic lymph nodes. MR imaging showed focal (n = 2) and diffuse (n = 2) enlargement with rimlike enhancement in one. MRCP revealed pancreatic duct strictures in two and sclerosing cholangitis-like appearance in one. Endoscopic US showed diffuse enlargement of pancreas with altered echotexture in 13 patients and focal mass in the head in six. ERCP showed stricture of distal common bile duct in 12 patients, irregular narrowing of intrahepatic ducts in six, diffuse irregular narrowing of pancreatic duct in nine, and focal stricture of proximal pancreatic duct in six. Serologic markers showed increased IgG and antinuclear antibody levels in seven of 12 patients. At follow-up, CT abnormalities and common bile duct strictures resolved after steroid therapy in three patients. CONCLUSION: Features that suggest autoimmune pancreatitis include focal or diffuse pancreatic enlargement, with minimal peripancreatic inflammation and absence of vascular encasement or calcification at CT and endoscopic US, and diffuse irregular narrowing of main pancreatic duct, with associated multiple biliary strictures at ERCP.

Original languageEnglish (US)
Pages (from-to)345-352
Number of pages8
JournalRadiology
Volume233
Issue number2
DOIs
StatePublished - Nov 2004

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Pancreatitis
Pancreatic Ducts
Pathologic Constriction
Endosonography
Endoscopic Retrograde Cholangiopancreatography
Pancreas
Antinuclear Antibodies
Tomography
Common Bile Duct
Immunoglobulin G
Magnetic Resonance Imaging
Magnetic Resonance Cholangiopancreatography
Inflammation
Vascular Calcification
Sclerosing Cholangitis
Cholangiography
Spiral Computed Tomography
Blood Vessels
Lymph Nodes
Steroids

Keywords

  • Magnetic resonance (MR), cholangiopancreatography, 77.121411, 77.121415
  • Pancreas, CT, 77.12115
  • Pancreas, MR, 77.121411, 77.121415
  • Pancreas, US, 77.1298
  • Pancreatitis, 77.291

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Sahani, D. V., Kalva, S. P., Farrell, J., Maher, M. M., Saini, S., Myeller, P. R., ... Simeone, J. F. (2004). Autoimmune pancreatitis: Imaging features. Radiology, 233(2), 345-352. https://doi.org/10.1148/radiol.2332031436

Autoimmune pancreatitis : Imaging features. / Sahani, Dushyant V.; Kalva, Sanjeeva P.; Farrell, James; Maher, Michael M.; Saini, Sanjay; Myeller, Peter R.; Lauwers, Gregory Y.; Fernandez, Carlos D.; Warshaw, Andrew L.; Simeone, Joseph F.

In: Radiology, Vol. 233, No. 2, 11.2004, p. 345-352.

Research output: Contribution to journalArticle

Sahani, DV, Kalva, SP, Farrell, J, Maher, MM, Saini, S, Myeller, PR, Lauwers, GY, Fernandez, CD, Warshaw, AL & Simeone, JF 2004, 'Autoimmune pancreatitis: Imaging features', Radiology, vol. 233, no. 2, pp. 345-352. https://doi.org/10.1148/radiol.2332031436
Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Myeller PR et al. Autoimmune pancreatitis: Imaging features. Radiology. 2004 Nov;233(2):345-352. https://doi.org/10.1148/radiol.2332031436
Sahani, Dushyant V. ; Kalva, Sanjeeva P. ; Farrell, James ; Maher, Michael M. ; Saini, Sanjay ; Myeller, Peter R. ; Lauwers, Gregory Y. ; Fernandez, Carlos D. ; Warshaw, Andrew L. ; Simeone, Joseph F. / Autoimmune pancreatitis : Imaging features. In: Radiology. 2004 ; Vol. 233, No. 2. pp. 345-352.
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AU - Kalva, Sanjeeva P.

AU - Farrell, James

AU - Maher, Michael M.

AU - Saini, Sanjay

AU - Myeller, Peter R.

AU - Lauwers, Gregory Y.

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N2 - PURPOSE: To retrospectively determine imaging findings in patients with autoimmune pancreatitis. MATERIALS AND METHODS: Twenty-nine patients (25 male and four female; mean age, 56 years; range, 15-82 years) with histopathologic diagnosis of autoimmune pancreatitis were examined. Data were reviewed by two radiologists in consensus. Imaging findings for review included those from helical computed tomography (CT), 25 patients; magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP), four patients; endoscopic ultrasonography (US), 21 patients; endoscopic retrograde cholangiopancreatography (ERCP), 19 patients; and percutaneous transhepatic cholangiography, one patient. Images were analyzed for appearances of pancreas, biliary and pancreatic ducts, and other findings, such as peripancreatic inflammation, encasement of vessels, mass effect, pancreatic calcification, peripancreatic nodes, and peripancreatic fluid collection. Follow-up images were available in nine patients. Serologic markers such as serum immunoglobulin G (IgG) and antinuclear antibody levels were available in 12 patients. RESULTS: CT showed diffuse (n = 14) and focal (n = 7) enlargement of pancreas. Seven patients had minimal peripancreatic stranding, with lack of vascular encasement, calcification, or peripancreatic fluid collection. Nine patients had enlarged peripancreatic lymph nodes. MR imaging showed focal (n = 2) and diffuse (n = 2) enlargement with rimlike enhancement in one. MRCP revealed pancreatic duct strictures in two and sclerosing cholangitis-like appearance in one. Endoscopic US showed diffuse enlargement of pancreas with altered echotexture in 13 patients and focal mass in the head in six. ERCP showed stricture of distal common bile duct in 12 patients, irregular narrowing of intrahepatic ducts in six, diffuse irregular narrowing of pancreatic duct in nine, and focal stricture of proximal pancreatic duct in six. Serologic markers showed increased IgG and antinuclear antibody levels in seven of 12 patients. At follow-up, CT abnormalities and common bile duct strictures resolved after steroid therapy in three patients. CONCLUSION: Features that suggest autoimmune pancreatitis include focal or diffuse pancreatic enlargement, with minimal peripancreatic inflammation and absence of vascular encasement or calcification at CT and endoscopic US, and diffuse irregular narrowing of main pancreatic duct, with associated multiple biliary strictures at ERCP.

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KW - Pancreas, US, 77.1298

KW - Pancreatitis, 77.291

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