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. 2019 Jan;290(1):207-215.
doi: 10.1148/radiol.2018181353. Epub 2018 Oct 16.

Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer

Temel Tirkes  1 , Zarine K Shah  1 , Naoki Takahashi  1 , Joseph R Grajo  1 , Stephanie T Chang  1 , Sudhakar K Venkatesh  1 , Darwin L Conwell  1 , Evan L Fogel  1 , Walter Park  1 , Mark Topazian  1 , Dhiraj Yadav  1 , Anil K Dasyam  1 ; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer  1
Affiliations

Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer

Temel Tirkes et al. Radiology. 2019 Jan.

Abstract

Chronic pancreatitis is an inflammatory condition of the pancreas with clinical manifestations ranging from abdominal pain, acute pancreatitis, exocrine and/or endocrine dysfunction, and pancreatic cancer. There is a need for longitudinal studies in well-phenotyped patients to ascertain the utility of cross-sectional imaging findings of chronic pancreatitis for diagnosis and assessment of disease severity. CT and MR cholangiopancreatography are the most common cross-sectional imaging studies performed for the evaluation of chronic pancreatitis. Currently, there are no universal reporting standards for chronic pancreatitis. Several features of chronic pancreatitis are applied clinically, such as calcifications, parenchymal T1 signal changes, focal or diffuse gland atrophy, or irregular contour of the gland. Such findings have not been incorporated into standardized diagnostic criteria. There is also lack of consensus on quantification of disease severity in chronic pancreatitis, other than by using ductal features alone as described in the Cambridge classification. The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC) was established by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute in 2015 to undertake collaborative studies on chronic pancreatitis, diabetes mellitus, and pancreatic adenocarcinoma. CPDPC investigators from the Adult Chronic Pancreatitis Working Group were tasked with development of a new consensus approach to reporting features of chronic pancreatitis aimed to standardize diagnosis and assessment of disease severity for clinical trials. This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Megibow in this issue.

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Figures

Figure 1a:
Figure 1a:
Images in a 49-year-old patient with history of alcohol abuse, chronic pancreatitis (CP), and cirrhosis. (a) Oblique axial contrast material–enhanced CT image shows moderately to markedly irregular pancreatic duct (PD) contour (white arrow) and stricture in pancreatic neck causing upstream ductal dilatation (black arrow). Distribution of findings is greater than 70% because there are features of CP involving entire gland. Relatively less enhancement of parenchyma is shown in region of head compared with body and tail. Delayed enhancement pattern is nonspecific; however, it can be seen with fibrosis. (b) Oblique coronal contrast-enhanced CT image shows head, neck, and body of pancreas with more than seven coarse calcifications (arrow). Largest PD caliber is measured as shown with white line. (c) Axial contrast-enhanced CT image shows measurement of pancreatic thickness in patient with PD dilatation, measured perpendicular to longitudinal axis of parenchyma at level of lateral margin of adjacent vertebral body (VB) or upstream to PD calculus or stricture. Splenic vein (SV) and artery in measurement should be avoided.
Figure 1b:
Figure 1b:
Images in a 49-year-old patient with history of alcohol abuse, chronic pancreatitis (CP), and cirrhosis. (a) Oblique axial contrast material–enhanced CT image shows moderately to markedly irregular pancreatic duct (PD) contour (white arrow) and stricture in pancreatic neck causing upstream ductal dilatation (black arrow). Distribution of findings is greater than 70% because there are features of CP involving entire gland. Relatively less enhancement of parenchyma is shown in region of head compared with body and tail. Delayed enhancement pattern is nonspecific; however, it can be seen with fibrosis. (b) Oblique coronal contrast-enhanced CT image shows head, neck, and body of pancreas with more than seven coarse calcifications (arrow). Largest PD caliber is measured as shown with white line. (c) Axial contrast-enhanced CT image shows measurement of pancreatic thickness in patient with PD dilatation, measured perpendicular to longitudinal axis of parenchyma at level of lateral margin of adjacent vertebral body (VB) or upstream to PD calculus or stricture. Splenic vein (SV) and artery in measurement should be avoided.
Figure 1c:
Figure 1c:
Images in a 49-year-old patient with history of alcohol abuse, chronic pancreatitis (CP), and cirrhosis. (a) Oblique axial contrast material–enhanced CT image shows moderately to markedly irregular pancreatic duct (PD) contour (white arrow) and stricture in pancreatic neck causing upstream ductal dilatation (black arrow). Distribution of findings is greater than 70% because there are features of CP involving entire gland. Relatively less enhancement of parenchyma is shown in region of head compared with body and tail. Delayed enhancement pattern is nonspecific; however, it can be seen with fibrosis. (b) Oblique coronal contrast-enhanced CT image shows head, neck, and body of pancreas with more than seven coarse calcifications (arrow). Largest PD caliber is measured as shown with white line. (c) Axial contrast-enhanced CT image shows measurement of pancreatic thickness in patient with PD dilatation, measured perpendicular to longitudinal axis of parenchyma at level of lateral margin of adjacent vertebral body (VB) or upstream to PD calculus or stricture. Splenic vein (SV) and artery in measurement should be avoided.
Figure 2a:
Figure 2a:
Images in a 47-year-old woman with chronic abdominal pain suspected of pancreatic origin. (a) Coronal thick-slab MR cholangiopancreatography image 10 minutes after secretin administration is shown, with pancreatic juice filling third portion of duodenum. The first, second, and third portions of duodenum are labeled as 1, 2, and 3. Main pancreatic duct (PD) diameter is 2.5 mm (arrowhead). There are at least four abnormal side-branches (arrows) consistent with Cambridge classification 2. Main PD contour is smooth with no PD strictures. (b) Axial unenhanced gradient-echo image shows region-of-interest measurement (circles) of T1-weighted signal in pancreas (arrow), spleen, paraspinal muscle, and liver.
Figure 2b:
Figure 2b:
Images in a 47-year-old woman with chronic abdominal pain suspected of pancreatic origin. (a) Coronal thick-slab MR cholangiopancreatography image 10 minutes after secretin administration is shown, with pancreatic juice filling third portion of duodenum. The first, second, and third portions of duodenum are labeled as 1, 2, and 3. Main pancreatic duct (PD) diameter is 2.5 mm (arrowhead). There are at least four abnormal side-branches (arrows) consistent with Cambridge classification 2. Main PD contour is smooth with no PD strictures. (b) Axial unenhanced gradient-echo image shows region-of-interest measurement (circles) of T1-weighted signal in pancreas (arrow), spleen, paraspinal muscle, and liver.
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