Magnetic Resonance Pancreatography (MRP)

Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology

Pancreatic and duodenal injuries after blunt abdominal trauma are rare; however, delays in diagnosis and treatment can significantly increase morbidity and mortality. Multidetector computed tomography (CT) has a major role in early diagnosis of pancreatic and duodenal injuries. Detecting the often subtle signs of injury with whole-body CT can be difficult because this technique usually does not include a dedicated protocol for scanning the pancreas. Specific injury patterns in the pancreas and duodenum often have variable expression at early posttraumatic multidetector CT: They may be hardly visible, or there may be considerable exudate, hematomas, organ ruptures, or active bleeding. An accurate multidetector CT technique allows optimized detection of subtle abnormalities. In duodenal injuries, differentiation between a contusion of the duodenal wall or mural hematoma and a duodenal perforation is vital. In pancreatic injuries, determination of involvement of the pancreatic duct is essential. The latter conditions require immediate surgical intervention. Use of organ injury scales and a surgical classification adapted for multidetector CT enables classification of organ injuries for trauma scoring, treatment planning, and outcome control. In addition, multidetector CT reliably demonstrates potential complications of duodenal and pancreatic injuries, such as posttraumatic pancreatitis, pseudocysts, fistulas, exudates, and abscesses.

MRI for the diagnosis of blunt abdominal trauma: a case report

Blunt abdominal trauma is a leading cause of trauma related mortality. Currently, the gold standard in the radiographic evaluation of intra-abdominal injury is computed tomography (CT) with iodinated contrast material. However, in the setting of renal failure or a previous anaphylactic reaction to contrast material, radiographic evaluation of the trauma patient may prove difficult. Without contrast material, the sensitivity of CT in the diagnosis of solid organ injury is diminished. We present a case report and literature review of magnetic resonance imaging in the evaluation of blunt abdominal trauma.

Imaging and Percutaneous Management of Acute Complicated Pancreatitis

Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care.

Clinical applications of magnetic resonance cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) is a novel imaging technique used for noninvasive work-up of patients with pancreaticobiliary disease. Magnetic resonance cholangiopancreatography is useful in the evaluation of a host of pancreaticobiliary disorders, such as congenital disorders, calculus disease, biliary strictures, sclerosing cholangitis, chronic pancreatitis, and cystic pancreatic lesions. It not only provides useful preoperative information to surgeons and gastroenterologists but also serves as a valuable tool in the assessment of postoperative pancreaticobiliary ductal anatomy. Recent refinement of techniques allows faster imaging with superior image resolution. This review summarizes the role of MRCP in clinical practice.

Chronic pancreatitis: diagnosis, classification, and new genetic developments

The utilization of recent advances in molecular and genomic technologies and progress in pancreatic imaging techniques provided remarkable insight into genetic, environmental, immunologic, and pathobiological factors leading to chronic pancreatitis. Translation of these advances into clinical practice demands a reassessment of current approaches to diagnosis, classification, and staging. We conclude that an adequate pancreatic biopsy must be the gold standard against which all diagnostic approaches are judged. Although computed tomography remains the initial test of choice for the diagnosis of chronic pancreatitis, the roles of endoscopic retrograde pancreatography, endoscopic ultrasonography, and magnetic resonance imaging are considered. Once chronic pancreatitis is diagnosed, proper classification becomes important. Major predisposing risk factors to chronic pancreatitis may be categorized as either (1) toxic-metabolic, (2) idiopathic, (3) genetic, (4) autoimmune, (5) recurrent and severe acute pancreatitis, or (6) obstructive (TIGAR-O system). After classification, staging of pancreatic function, injury, and fibrosis becomes the next major concern. Further research is needed to determine the clinical and natural history of chronic pancreatitis developing in the context of various risk factors. New methods are needed for early diagnosis of chronic pancreatitis, and new therapies are needed to determine whether interventions will delay or prevent the progression of the irreversible damage characterizing end-stage chronic pancreatitis.