Chronic pancreatitis diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]
Overview
The diagnostic study of choice for chronic pancreatitis is magnetic resonance cholangiopancreatography (MRCP). The diagnosis is difficult to establish because the laboratory results and the imaging may be normal. Diagnostic findings confirmatory for chronic pancreatitis may include pancreatic calcifications seen on abdominal plain films or CT scan, beaded appearance of main pancreatic duct seen on pancreatogram. Abnormal pancreatogram shows ectatic side branches from the main pancreatic duct and abnormal pancreatic function tests (Secretin stimulation test).
Diagnostic Study of Choice
Gold standard or study of choice:
- The diagnostic study of choice for chronic pancreatitis is magnetic resonance cholangiopancreatography (MRCP) because:
- It may help in the detailed assessment of the ductal changes.
- It eliminates the need to perform endoscopic retrograde cholangiopancreatography (ERCP).
Diagnostic Criteria
- The diagnosis is difficult to establish as the laboratory results and the imaging may be normal.
Diagnostic findings suggestive of chronic pancreatitis:
Diagnostic findings suggestive of chronic pancreatitis include the triad of:
Diagnostic findings confirmatory for Chronic pancreatitis:
Diagnostic findings confirmatory for chronic pancreatitis may include
- Pancreatic calcifications seen on abdominal plain films or CT scan
- Beaded appearance of main pancreatic duct seen on pancreatogram
- Abnormal pancreatogram showing ectatic side branches from the main pancreatic duct
- Abnormal pancreatic function tests (Secretin test)
M-ANNHEIM diagnostic criteria of chronic pancreatitis
- The diagnosis usually requires a typical history of chronic pancreatitis (recurrent pancreatitis or abdominal pain).
- The diagnosis for the various forms of chronic pancreatitis can be established by the following features.
| Form of chronic pancreatitis | Diagnostic criteria |
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| Definite chronic pancreatitis | Established by one or more of the following additional criteria:
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| Probable chronic pancreatitis | Established by one or more of the following additional criteria:
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| Borderline chronic pancreatitis | Established as a first episode of acute pancreatitis with or without:
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| Pancreatitis associated with alcohol consumption | Requires in addition to the above-mentioned criteria for definite, probable, or borderline chronic pancreatitis one of the following features:
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M-ANNHEIM pancreatic imaging criteria for US, CT, MRI/MRCP, and EUS based on imaging features as defined by the Cambridge classification
| Cambridge grading | CT, US, MRI/MRCP | EUS |
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| Normal | Quality study depicting whole gland without abnormal features | |
| Equivocal | One abnormal feature | Four or fewer abnormal features (no differentiation between equivocal and mild) |
| Mild changes | Two or more abnormal features, but normal main pancreatic duct | |
| Moderate changes | Two or more abnormal features, including minor main Five or more abnormal features pancreatic duct abnormalities (either enlargement between 2 and 4 mm or increased echogenicity of the duct wall) | Five or more abnormal features (no differentiation between moderate and marked) |
| Marked changes | As above with one or more of the required features of marked changes |