Preliminary Diagnosis: Chronic Pancreatitis
I. What imaging technique is first-line for this diagnosis?
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CT of the abdomen and pelvis with contrast
II. Describe the advantages and disadvantages of this technique for diagnosis of chronic pancreatitis.
Advantages
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Quick
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Inexpensive
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Specific for diagnosis
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Can detect associated findings with chronic pancreatitis, including masses, pseudocyts, and others
Disadvantages
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May be difficult to see imaging findings of chronic pancreatitis without administration of intravenous contrast.
III. What are the contraindications for the first-line imaging technique?
Relative contraindication includes pregnancy
IV. What alternative imaging techniques are available?
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MRI with and without contrast
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Magnetic resonance cholangiopancreatography (MRCP)
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Ultrasonography
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Plain radiographs
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Endoscopic retrograde cholangiopancreatography (ERCP)
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of chronic pancreatitis.
MRI with and without contrast
Advantages
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Diagnostic
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Can accurately detect associated findings
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Does not require the use of ionizing radiation
Disadvantages
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Time consuming
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Expensive
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Requires significant patient cooperation to minimize motion artifact
MRCP
Advantages
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Can often see well-depicted fluid-containing structures
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Can offer significant detail of bilary tract
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Does not require the use of ionizing radiation
Disadvantages
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Time consuming
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Expensive
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Requires significant patient cooperation to minimize motion artifact
Ultrasonography
Advantages
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Inexpensive
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Can detect dilated common bile duct and a dilated major pancreatic duct
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Does not require the use of ionizing radiation
Disadvantages
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Often difficult to appreciate abnormalities of the pancreas and associated vessels and soft tissue structures
Plain radiographs
Advantages
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Inexpensive
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Quick
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Portable
Disadvantages
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Lacks sensitivity or specificity for diagnosis
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Usually requires abundant pancreatic calcifications for meaningful diagnosis
ERCP
Advantages
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Can perform therapeutic manuevers if appropriate
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Can perform additional diagnostic maneuvers including biopsy
Disadvantages
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Exposure to ionizing radiation
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Time consuming
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Operator dependent
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Invasive
VI. What are the contraindications for the alternative imaging techniques?
MRI with and without contrast
Absolute contraindication is non-MR-compatible hardware devices
MRCP
Absolute contraindication is non-MR-compatible hardware devices
Ultrasonography
No significant contraindications
Plain radiographs
May require consent in pregnant patients at some institutions
ERCP
Relative contraindication includes pregnancy
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