Preliminary Diagnosis: Acute pancreatitis

I. What imaging technique is first-line for this diagnosis?

CT of the abdomen and pelvis with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of acute pancreatitis.

Advantages

  • Can identify focal or diffuse pancreatic enlargment

  • Can identify necrotic areas, abscesses, pseudocysts, and other fluid collections

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  • Quick

  • Relatively inexpesnsive

  • Test can be diagnostic

Disadvantages

  • No significant disadvantages

III. What are the contraindications for the first-line imaging technique?

  • Relative contraindication includes pregnancy

IV. What alternative imaging techniques are available?

  • MRI abdomen with and without contrast

  • MRCP

  • ERCP

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of acute pancreatitis.

MRI abdomen with and without contrast
Advantages

  • Can see fluid collections, pseudocyst(s), necrotic areas, gallstones or intraductal calculi, vascular occlusions

Disadvantages

  • Requires significant patient cooperation for image quality

  • Expensive

  • Time consuming

MRCP
Advantages

  • Can see dilated or normal main pancreatic duct or possibly pseudocyst contiguous with main pancreatic duct

Disadvantages

  • Requires significant patient cooperation for image quality

  • Expensive

  • Time consuming

  • Limited assessment of the pancreatic parenchyma

ERCP
Advantages

  • May show dilated or normal main pancreatic duct (MPD), possible communication of pseudocyst with MPD (acutely)

  • May show narrowed and tapered distal common bile duct (CBD) with prestenotic biliary dilatation

  • May be able to intervene and remove gallstone if it is the etiology of the pancreatitis (therapeutic ERCP)

Disadvantages

  • Exposure to ionizing radiation

  • Limited assessment of pancreatic parenchyma

Ultrasound
Advantages

  • May show enlarged hypoechoic pancreas, fluid collection, abscess, or pseudocyst

Disadvantages

  • Limited evaluation of the pancreas and pancreatic ducts

  • Overlying bowel gas and large body habitus limit visualization

VI. What are the contraindications for the alternative imaging techniques?

MRI abdomen with and without contrast

  • Non-MR-compatible hardware

MRCP

  • Non-MR-compatible hardware

ERCP

  • Relative contraindication if patient is pregnant

Ultrasound

  • No significant contraindication

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