This system was designed to facilitate understanding and correlation of findings seen by gastroenterologists, pathologists, radiologists and surgeons aiding improved communication between clinicians. In 1992, the Atlanta classification for acute pancreatitis was introduced to establish international standards of definitions of acute pancreatitis and its complications. In order to assess and predict local or systemic effects of pancreatic injury, several disease severity-scoring systems were developed ( e.g., Ranson score, APACHE-II). If abdominal pain is strongly suggestive of acute pancreatitis but the serum amylase and/or lipase activity is less than 3 times the upper limit of normal, characteristic findings on a CECT or MRI are required to confirm the diagnosis. There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: (1) Sudden onset abdominal pain suggestive of acute pancreatitis (epigastric pain radiating to the back) (2) Serum amylase and/or lipase levels at least 3 times greater than the upper limit of normal and (3) Characteristic imaging findings of acute pancreatitis on contrast-enhanced computerized tomography (CECT), MRI, or transabdominal ultrasonography (US) studies. The purpose of our review is to illustrate the different imaging findings of pancreatitis on computed tomography (CT) and magnetic resonance imaging (MRI) with special emphasis on the revised terminology for acute pancreatitis and substantiate the increasing importance of imaging in the diagnosis, staging and follow-up of acute and chronic pancreatitis.Īcute pancreatitis results from the exudation of fluid containing activated proteolytic enzymes into the interstitium of the pancreas and leakage of this fluid into surrounding tissue. Alcohol consumption accounts for the majority (80%) of cases of chronic pancreatitis in adults in developed countries whereas malnutrition is the most common cause worldwide. The incidence of chronic pancreatitis is between five and twelve cases per 100000 persons per year accounting for more than 120000 outpatient visits and 50000 hospitalizations annually. Over one-half of cases of acute pancreatitis in adults are related to cholelithiasis or alcohol consumption whereas trauma, viral infections and systemic diseases account for the majority of cases in children. However, a subset of patients develop severe disease independent of the degree of initial insult or etiology, with high morbidity and mortality up to 45%.
Acute pancreatitis was the most common gastrointestinal diagnosis for hospitalization (with 274119 discharges) in the United States in 2009, usually running a mild clinical course. The incidence of acute pancreatitis is increasing in the United States and worldwide contributing to be one of the major sources of hospitalization. It can be acute representing an acute inflammatory process of the pancreas, or chronic progressing slowly with continued, permanent inflammatory injury to the pancreas. Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. It also describes the spectrum of early and late chronic pancreatitis imaging findings and illustrates some of the less common types of chronic pancreatitis, with special emphasis on the role of CT and MRI. This article reviews the proposed definitions of revised Atlanta classification for acute pancreatitis, illustrates a wide range of morphologic pancreatic parenchymal and associated peripancreatic changes for different types of acute pancreatitis.
However, magnetic resonance imaging (MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization.
In the setting of pancreatitis, wider availability and good image quality make multi-detector contrast-enhanced computed tomography (MD-CECT) the most used imaging technique. Imaging plays a significant role in the diagnosis, severity assessment, recognition of complications and guiding therapeutic interventions.
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