EURORAD ESR

Case 14183

Acute pancreatitis in Crohn’s disease: diagnostic value of diffusion-weighted MRI

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 43 year(s)
 
 
  • Figure 1
    Initial (January 2015) unenhanced and post-contrast multidetector CT
     

    Preliminary unenhanced acquisition revealed normal-sized pancreas with mild fat stranding (+) surrounding the tail, in absence of peripancreatic fluid collections, fascial and peritoneal effusion.

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections,...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections,...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections,...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections,...

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 2
    Initial (January 2015) MR-cholangiopancreatography (MRCP)
     

    At hospital discharge, fat-suppressed T1-weighted images (a,b) confirmed normal size and configuration of the pancreatic gland.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    At hospital discharge, fat-suppressed T1-weighted images (a,b) confirmed normal size and configuration of the pancreatic gland.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    Axial (c) and coronal (d) T2-weighted images confirmed normal size, configuration and signal intensity of the pancreatic gland. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    Axial (c) and coronal (d) T2-weighted images confirmed normal size, configuration and signal intensity of the pancreatic gland. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Acute;

    MRCP images showed normally distended gallbladded, non-dilated intrahepatic bile ducts, normal caliber of the main bile ducts without appreciable lithiasis. The normal-appearing main pancreatic duct of Wirsung...

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;
     
     
  • Figure 3
    Current (September 2016) unenhanced and post-contrast multidetector CT
     

    Preliminary unenhanced images showed post-cholecystectomy status (note metallic clips), normal size and configuration of the pancreas, subtle fat stranding (+) surrounding the pancreatic head and uncinate process....

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Preliminary unenhanced images showed post-cholecystectomy status (note metallic clips), normal size and configuration of the pancreas, subtle fat stranding (+) surrounding the pancreatic head and uncinate process....

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Post-contrast acquisition confirmed normal-sized pancreas with preserved homogeneous enhancement, absence of peripancreatic collections, fascial fluid and peritoneal effusion.

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;

    Post-contrast acquisition confirmed normal-sized pancreas with preserved homogeneous enhancement, absence of peripancreatic collections, fascial fluid and peritoneal effusion. Note metallic clips in d.

     
    Area of Interest: Pancreas; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 4
    Current (September 2016) MR-cholangiopancreatography (MRCP)
     

    Fat-suppressed T1-weighted images showed normal size and configuration of the pancreatic gland, unchanged compared to Fig.2. Note previous cholecystectomy.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    Fat-suppressed T1-weighted images showed normal size and configuration of the pancreatic gland, unchanged compared to Fig.2. Note previous cholecystectomy.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal...

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal...

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal...

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;

    MRCP showed non-dilated intrahepatic bile ducts, long cystic duct remnant after cholecystectomy, normal caliber of the main bile duct without appreciable lithiasis, normal-appearing main pancreatic duct of Wirsung.

     
    Area of Interest: Pancreas; Imaging Technique: MR; Procedure: Cholangiography; Special Focus: Acute;
     
     
  • Figure 5
    Current (September 2016) MR - Diffusion-weighted images
     

    Diffusion-weighted (b=800) images (a,b) showed homogeneously hyperintense signal of the pancreatic gland (arrowheads), compared to usual pancreatic appearance as shown in Figure 6.

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Dilation; Special Focus: Acute;

    Diffusion-weighted (b=800) images (a,b) showed homogeneously hyperintense signal of the pancreatic gland (arrowheads), compared to usual pancreatic appearance as shown in Figure 6.

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;

    Apparent diffusion coefficient (ADC) maps (c,d) showed corresponding strong hypointensity of the pancreas (arrowheads), compared to usual appearance in Figure 6. Measured ADC values ranged between 0.85 and 1.08 x 10-3...

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;

    Apparent diffusion coefficient (ADC) maps (c,d) showed corresponding strong hypointensity of the pancreas (arrowheads), compared to usual appearance in Figure 6. Measured ADC values ranged between 0.85 and 1.08 x 10-3...

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
  • Figure 6
    Normal diffusion-MRI appearance of the pancreas in a healthy patient
     

    Showed for comparison, diffusion-weighted (b=800) images (a, b) showed normal signal intensity of a healthy pancreatic gland (arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;

    Showed for comparison, diffusion-weighted (b=800) images (a, b) showed normal signal intensity of a healthy pancreatic gland (arrowheads).

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;

    Corresponding apparent diffusion coefficient (ADC) maps (c,d) showed normal intensity of the healthy pancreatic gland (arrowheads), to be compared with Figure 5.

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;

    Corresponding apparent diffusion coefficient (ADC) maps (c,d) showed normal intensity of the healthy pancreatic gland (arrowheads), to be compared with Figure 5.

     
    Area of Interest: Pancreas; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
Preliminary unenhanced acquisition revealed normal-sized pancreas with mild fat stranding (+) surrounding the tail, in absence of peripancreatic fluid collections, fascial and peritoneal effusion.
 
Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections, fascial and peritoneal effusion.
 
Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections, fascial and peritoneal effusion.
 
Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections, fascial and peritoneal effusion.
 
Contrast-enhanced images (b...e) showed normal size and configuration of the pancreatic gland, with normal homogeneous enhancement thereby excluding necrosis. Confirmed absence of peripancreatic fluid collections, fascial and peritoneal effusion.
 
At hospital discharge, fat-suppressed T1-weighted images (a,b) confirmed normal size and configuration of the pancreatic gland.
 
At hospital discharge, fat-suppressed T1-weighted images (a,b) confirmed normal size and configuration of the pancreatic gland.
 
Axial (c) and coronal (d) T2-weighted images confirmed normal size, configuration and signal intensity of the pancreatic gland. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.
 
Axial (c) and coronal (d) T2-weighted images confirmed normal size, configuration and signal intensity of the pancreatic gland. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.
 
MRCP images showed normally distended gallbladded, non-dilated intrahepatic bile ducts, normal caliber of the main bile ducts without appreciable lithiasis. The normal-appearing main pancreatic duct of Wirsung excluded pancreas divisum as possible cause of pancreatitis.
 
Preliminary unenhanced images showed post-cholecystectomy status (note metallic clips), normal size and configuration of the pancreas, subtle fat stranding (+) surrounding the pancreatic head and uncinate process. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.
 
Preliminary unenhanced images showed post-cholecystectomy status (note metallic clips), normal size and configuration of the pancreas, subtle fat stranding (+) surrounding the pancreatic head and uncinate process. Absence of peripancreatic collections, fascial fluid and peritoneal effusion.
 
Post-contrast acquisition confirmed normal-sized pancreas with preserved homogeneous enhancement, absence of peripancreatic collections, fascial fluid and peritoneal effusion.
 
Post-contrast acquisition confirmed normal-sized pancreas with preserved homogeneous enhancement, absence of peripancreatic collections, fascial fluid and peritoneal effusion. Note metallic clips in d.
 
Fat-suppressed T1-weighted images showed normal size and configuration of the pancreatic gland, unchanged compared to Fig.2. Note previous cholecystectomy.
 
Fat-suppressed T1-weighted images showed normal size and configuration of the pancreatic gland, unchanged compared to Fig.2. Note previous cholecystectomy.
 
T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal effusion. Note previous cholecystectomy.
 
T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal effusion. Note previous cholecystectomy.
 
T2-weighted images (c...e) showed normal size, configuration and signal intensity of the pancreatic gland, unchanged from Figure 2. Persistent absence of peripancreatic collections, fascial fluid and peritoneal effusion. Note previous cholecystectomy.
 
MRCP showed non-dilated intrahepatic bile ducts, long cystic duct remnant after cholecystectomy, normal caliber of the main bile duct without appreciable lithiasis, normal-appearing main pancreatic duct of Wirsung.
 
Diffusion-weighted (b=800) images (a,b) showed homogeneously hyperintense signal of the pancreatic gland (arrowheads), compared to usual pancreatic appearance as shown in Figure 6.
 
Diffusion-weighted (b=800) images (a,b) showed homogeneously hyperintense signal of the pancreatic gland (arrowheads), compared to usual pancreatic appearance as shown in Figure 6.
 
Apparent diffusion coefficient (ADC) maps (c,d) showed corresponding strong hypointensity of the pancreas (arrowheads), compared to usual appearance in Figure 6. Measured ADC values ranged between 0.85 and 1.08 x 10-3 mm2/s.
 
Apparent diffusion coefficient (ADC) maps (c,d) showed corresponding strong hypointensity of the pancreas (arrowheads), compared to usual appearance in Figure 6. Measured ADC values ranged between 0.85 and 1.08 x 10-3 mm2/s.
 
Showed for comparison, diffusion-weighted (b=800) images (a, b) showed normal signal intensity of a healthy pancreatic gland (arrowheads).
 
Showed for comparison, diffusion-weighted (b=800) images (a, b) showed normal signal intensity of a healthy pancreatic gland (arrowheads).
 
Corresponding apparent diffusion coefficient (ADC) maps (c,d) showed normal intensity of the healthy pancreatic gland (arrowheads), to be compared with Figure 5.
 
Corresponding apparent diffusion coefficient (ADC) maps (c,d) showed normal intensity of the healthy pancreatic gland (arrowheads), to be compared with Figure 5.
 
 
 
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