MRI of Pancreatitis and Its Complications: Part 1, Acute Pancreatitis
Frank H. Miller1,
Ana L. Keppke1,
Kshitij Dalal1,
John N. Ly2,
Vilim-Alan Kamler1 and
Gregory T. Sica3
1 Department of Radiology, Northwestern Memorial Hospital, Northwestern
University, The Feinberg School of Medicine, 676 N Saint Clair St., Ste. 800,
Chicago, IL 60611.
2 Department of Radiology, Saint Vincent Medical Imaging, Level 5, 438 Victoria
St., Darling Hurst, NSW 2010, Australia.
3 Diagnostic Imaging Center, Harvard Vanguard Medical Associates, 133 Brookline
Ave., 1st Fl., Boston, MA 02115.
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Fig. 1A. —62-year-old man with normal pancreas on MRI. Axial
T2-weighted HASTE image shows signal intensity of pancreas is similar to that
of liver. Note pancreatic duct is not dilated.
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Fig. 1B. —62-year-old man with normal pancreas on MRI. Axial
T1-weighted fat-suppressed spoiled gradient-echo image shows high signal
intensity of pancreas due to presence of acinar proteins.
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Fig. 1C. —62-year-old man with normal pancreas on MRI. Axial enhanced
T1-weighted fat-suppressed spoiled gradient-echo image obtained during
arterial phase shows marked enhancement of pancreas relative to other
organs.
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Fig. 1D. —62-year-old man with normal pancreas on MRI. Axial enhanced
T1-weighted fat-suppressed spoiled gradient-echo image obtained during venous
phase shows washout of contrast material from pancreas.
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Fig. 2A. —75-year-old woman with choledocholithiasis and abnormal
results on liver function tests. Coronal T2-weighted HASTE image shows
multiple signal-void stones (arrows) surrounded by
high-signal-intensity bile in common bile duct.
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Fig. 2B. —75-year-old woman with choledocholithiasis and abnormal
results on liver function tests. Axial T2-weighted HASTE image shows stone of
common bile duct (short arrow) and gallstones (long
arrow).
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Fig. 3A. —69-year-old man with acute pancreatitis. Coronal enhanced
T1-weighted fat-suppressed spoiled gradient-echo image obtained during venous
phase shows enlarged pancreas with inflammation surrounding pancreatic tail
(arrow).
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Fig. 3B. —69-year-old man with acute pancreatitis. Coronal T2-weighted
RARE image shows relatively normal pancreatic duct (arrowhead) and
common bile duct (CBD). Note luminal narrowing of duodenum (arrows)
due to involvement by inflammation from pancreatitis. GB = gallbladder.
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Fig. 4A. —55-year-old woman with cholangiocarcinoma and pancreatitis
after ERCP. Axial T2-weighted HASTE image shows peripancreatic fluid
(arrows) and mildly increased signal intensity of pancreas due to
edema.
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Fig. 4B. —55-year-old woman with cholangiocarcinoma and pancreatitis
after ERCP. Axial T1-weighted fat-suppressed spoiled gradient-echo image shows
normal high signal intensity of pancreas. Note pancreatic signal intensity may
be normal on T1-weighted fat-suppressed spoiled gradient-echo sequence in
cases of uncomplicated acute pancreatitis as opposed to cases of cancer or
chronic pancreatitis when the pancreas has low-signal-intensity abnormalities.
Peripancreatic fluid is better seen on T2-weighted images.
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Fig. 4C. —55-year-old woman with cholangiocarcinoma and pancreatitis
after ERCP. Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo
image obtained during arterial phase shows diffusely decreased pancreatic
enhancement compared with normal pancreas, which is shown in
Figure 1C.
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Fig. 5. —45-year-old woman with pancreatitis after ERCP. Axial
enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained
during venous phase shows heterogeneous pancreatic enhancement due to
pancreatitis with peripancreatic fluid and inflammation (straight
arrows). Fluid (curved arrow) is seen between pancreas and
splenic vein. P = pancreas.
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Fig. 6A. —36-year-old man with metastatic pancreatic adenocarcinoma
mimicking acute pancreatitis. Axial T1-weighted fat-suppressed spoiled
gradient-echo image shows mild enlargement and decreased signal intensity of
body and tail of pancreas.
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Fig. 6B. —36-year-old man with metastatic pancreatic adenocarcinoma
mimicking acute pancreatitis. Axial T1-weighted fat-suppressed spoiled
gradient-echo image shows normal high signal intensity of pancreatic head.
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Fig. 6C. —36-year-old man with metastatic pancreatic adenocarcinoma
mimicking acute pancreatitis. Axial enhanced T1-weighted fat-suppressed
spoiled gradient-echo image obtained during venous phase shows decreased
enhancement of body and tail of pancreas. Mild peripancreatic inflammation is
present. Note abnormal soft tissue (arrow) to left of superior
mesenteric artery due to tumor.
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Fig. 7A. —50-year-old woman with gallstone pancreatitis. Axial enhanced
T1-weighted fat-suppressed spoiled gradient-echo image obtained during venous
phase shows large pseudocyst, which communicates with common bile duct.
Peripancreatic fluid is seen anterior to pancreatic tail. Marked
peripancreatic inflammatory changes (arrows) are seen.
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Fig. 7B. —50-year-old woman with gallstone pancreatitis. Radiograph
obtained after injection of contrast material into drainage catheter shows
contrast material is visible in common bile duct (arrow) consistent
with fistula.
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Fig. 8A. —60-year-old man with gallstone pancreatitis and pseudocyst.
Unenhanced axial CT scan shows lobulated pseudocyst (arrow) located
anteroinferior to pancreas. Internal content of pseudocyst is not well
characterized. IV contrast material was contraindicated because of poor renal
function.
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Fig. 8B. —60-year-old man with gallstone pancreatitis and pseudocyst.
Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained
during arterial phase shows peripheral enhancement of pseudocyst
(arrow).
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Fig. 8C. —60-year-old man with gallstone pancreatitis and pseudocyst.
Axial T2-weighted HASTE image shows septations and debris inside pseudocyst
(arrow).
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Fig. 9A. —59-year-old man with history of pancreatitis and large
pseudocyst drained from lesser sac. Axial enhanced T1-weighted fat-suppressed
spoiled gradient-echo image obtained during venous phase shows lack of
enhancement of body and tail of pancreas (arrows), which is
consistent with pancreatic necrosis.
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Fig. 9B. —59-year-old man with history of pancreatitis and large
pseudocyst drained from lesser sac. Axial T2-weighted HASTE image shows
pancreas (arrows) is markedly hypointense from necrosis and not
hyperintense like fluid as it would be if it were a pseudocyst.
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Fig. 10A. —56-year-old man with history of acute myelogenous leukemia
treated by chemotherapy who presented with abdominal pain suspected to be
acute pancreatitis. Axial contrast-enhanced CT scan shows lack of enhancement
of multiple areas in pancreas (arrows). It is difficult to determine
whether this finding represents pancreatic necrosis, a dilated duct due to
obstruction, or intraductal papillary mucinous tumor. Mild peripancreatic
inflammation is present.
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Fig. 10B. —56-year-old man with history of acute myelogenous leukemia
treated by chemotherapy who presented with abdominal pain suspected to be
acute pancreatitis. Axial enhanced T1-weighted fat-suppressed spoiled
gradient-echo image obtained during venous phase shows nonenhancing necrotic
areas (arrows) in body and tail of pancreas.
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Fig. 10C. —56-year-old man with history of acute myelogenous leukemia
treated by chemotherapy who presented with abdominal pain suspected to be
acute pancreatitis. Axial T2-weighted HASTE image shows nonenhancing area is
neither simple fluid nor pancreatic duct because it is not bright on
T2-weighted image; instead, area is necrotic pancreas.
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Fig. 11A. —52-year-old man with acute pancreatitis and abscess. Axial
enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained
during venous phase shows irregular enhancement of wall of abscess. Note gas
bubble (arrow) within abscess.
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Fig. 11B. —52-year-old man with acute pancreatitis and abscess. Coronal
T2-weighted HASTE image shows low-signal-intensity debris (arrow)
within pancreatic abscess (A). S = stomach.
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Fig. 12A. —55-year-old woman with history of pancreatitis and
pseudocyst. Axial T1-weighted fat-suppressed spoiled gradient-echo image shows
high-signal-intensity abnormality (arrow) from hemorrhagic fluid
within pseudocyst in pancreatic tail.
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Fig. 12B. —55-year-old woman with history of pancreatitis and
pseudocyst. Axial T2-weighted HASTE image shows low-signal-intensity rim
(arrow) in pseudocyst. Diagnosis of hemorrhage is easily made on MRI
due to hemosiderin rim.
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Fig. 13. —45-year-old woman with history of acute pancreatitis and
splenic artery pseudoaneurysm. Axial enhanced T1-weighted fat-suppressed
spoiled gradient-echo image shows splenic artery pseudoaneurysm
(arrow) enhancing similar to arteries.
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Fig. 14. —35-year-old woman with episode of acute pancreatitis and
splenic vein thrombus. Axial enhanced T1-weighted fat-suppressed spoiled
gradient-echo image obtained during venous phase shows low-signal-intensity
thrombus (arrowheads) in splenic vein.
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Copyright © 2004 by the American Roentgen Ray Society.
