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RADIOLOGI
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7/21/2019 Imaging Of Acute Pancreatitis
http://slidepdf.com/reader/full/imaging-of-acute-pancreatitis 1/25
Dwiva Wulan Guri
11-086
Imaging Of Acute Pancreatitis
7/21/2019 Imaging Of Acute Pancreatitis
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Denition Te clinical !enition of acute "ancreatitis
re#uires two of te following features$
%1& A'!ominal "ainstrongl( suggestive of
acute "ancreatitis)
%*& +erum am(lasean!,or li"ase activit(at least tree times
greater tan te u""er
limit of normal%& caracteristicn!ings of acute"ancreatitis onimaging.
7/21/2019 Imaging Of Acute Pancreatitis
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PaseAcute "ancreatitis is caracterise! '( two
!istinct "ases$
/arl( or interstitial"ase lasts
a""roimatel( 1wee an! is
!ominate! '( a
s(stemicin2ammator(
res"onse.
+econ! "ase"ancreatic
in2ammationresolves3 sta'ilisesor "rogresses into
necrotising"ancreatitis tatcan last wees or
monts.
7/21/2019 Imaging Of Acute Pancreatitis
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Pato"isiolog(Acute "ancreatitis can 'e consi!ere! in two !istinct
"ases. Te rst "ase usuall( lasts a'out a wee an!is !ominate! '( te s(stemic in2ammator( res"onses(n!rome %+I4+& cause! '( te release ofin2ammator( me!iators in res"onse to tissue in5ur(.
Disease severit( is associate! wit organ !amage an!is relate! to te s(stemic in2ammator( res"onserater tan te etent of "ancreatic necrosis. Duringtis "ase "atient assessmentis 'ase! on clinicalin!icators rater tan imaging. In te secon! "ase
te "ancreatic in2ammation ma( resolve3 sta'ilise or"rogress to necrotising "ancreatitis tat can run a"rotracte! course lasting wees or monts.
7/21/2019 Imaging Of Acute Pancreatitis
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Imaging Tecni#ues
7/21/2019 Imaging Of Acute Pancreatitis
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/sta'lis te
!iagnosis3 I!entif( aetiolog(
Assess an(com"lication
Te role ofimaging is
treefol!
7/21/2019 Imaging Of Acute Pancreatitis
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T tecni#ueImages are o'taine! using contrast-
enance! T %/T&3 aiming for o"timalvascular an! "arenc(mal enancementwit minimal res"irator( motion artefact.
Te !iagnosis of necrotising "ancreatitis!e"en!s on an assessment of "ancreatic"arenc(mal enancement.
An evaluation ma!e easier '( com"aring"re- an! "ost-contrast images.
7/21/2019 Imaging Of Acute Pancreatitis
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/sta'ilis Te Diagnosis Te clinical !enition of acute "ancreatitis %weter
on a 'acgroun! of cronic "ancreatitis or not&re#uires two of te following tree features$ %1&a'!ominal "ain strongl( suggestive of acute"ancreatitis) %*& serum am(lase an!,or li"ase at least
tree times greater tan te u""er limit of normal)%& caracteristic n!ings of acute "ancreatitis onimaging %/T is te imaging tecni#ue of coice&.
Imaging is not usuall( re#uire! for !iagnosis 'ut weretere is clinical !ou't T can conrm acute"ancreatitis or o7er an alternative !iagnosis for te"atients "resentation.
7/21/2019 Imaging Of Acute Pancreatitis
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/sta'ilising te aetiolog(
Gallstone !isease
Develo"mentala'normalities of te
"ancreatico'iliar( tree
Autoimmune"ancreatitis
7/21/2019 Imaging Of Acute Pancreatitis
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Autoimmune "ancreatitis. Aial contrast-enance! T images *(ears a"art !emonstrate te rela"sing nature of tis !isease.Images sow !i7use enlargement of te "ancreas3 wic is of lowerattenuation tan e"ecte!3 an! !is"la(s a latticewor enancementaccom"anie! '( a "eri"eral rin! of low soft tissue attenuation.9ulti"le we!ge-sa"e! low attenuation lesions seen witin te renal
corte %arrows& re2ect renal involvement3 foun! in u" to :;"atients.
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Imaging n!ings in acute
"ancreatitis
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Aial T sowing enlargement of te"ancreas wit striing "eri-renal s"aringan! etra"ancreatic in2ammator(cange a7ecting te colon.
+evere acute"ancreatitis
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+evere acute"ancreatitis
Aial contrast-enance! T from a!i7erent "atient wit gallstone"ancreatitis sowing are!gastric ticening giving rise to
clinical gastric outlet o'struction%arrow&.
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+evere acute"ancreatitis
Te same "atient also sows
mare! colonic an! "roimalsmall 'owel wall ticening%arrows&
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Pancreaticnecrosis
Pancreatitis secon!ar( togallstones. Aial T sowing
non-enancement of .0; of tenec an! 'o!( of te "ancreas3wit a stone seen in te !istalcommon 'ile !uct %arrow&.
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Pancreaticnecrosis
Arterial "ase aial image from a"atientclinicall( tougt to ave a ru"ture!aortic aneur(sm. Arterial "ase image
sows glo'al ("o"erfusion of te"ancreas wit avi! enancement of tea!renal glan! %wite arrow& an! 2atinferior vena cava %'lac rrow&in!icative of te "atientsclinicall( soce! status.
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Pancreaticnecrosis
9o!ie! coronal "ro5ection in arterial"ase sows te relative non-
enancement of te entire "ancreas3o'vious wen com"are! wit teenancement of te s"leen %witearrow&.
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Peri Pancreaticnecrosis
aial contrast-enance! T sowing !i7use
enlargement of te "ancreas wit surroun!ingin2ammator( cange3 'ut no evi!ence of"arenc(mal necrosis. <owever3 tere isin2ammator( cange involving te "eri-"ancreatic fat wit a low soft tissue !ensit( rin!consistent wit "eri-"ancreatic necrosis %arrow&.
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7/21/2019 Imaging Of Acute Pancreatitis
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Infecte!"ancreaticnecrosis
Aial contrastenance! T sowsetensive gas formation at te site of"ancreatic necrosis wit no !iscerna'le2ui! com"onent an! free intra"eritonealgas tracing nteriorl( %arrow&.
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Infecte! necrosis
ontrast-enance! aial T sowsmature 2ui! collection in an area of"revious necrosis containing foci of gasarrow&.
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om"lication
=asular
Gastrointestinal
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>lee! into a"ancreatic"seu!oc(st
is sown '( te ig attenuation 2ui!witin te c(st %arrow& tat coul! easil(ave 'een misse! on "ost-contrast
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Pseu!oaneur(sm
large "seu!oaneur(sm tat a! stulate! into tesu"erior mesenteric vein an! conrme! atangiogra"( to 'e fe! from te gastro!uo!enalarter(. ?arge collateral vessels can 'e seen aroun!te !uo!enum %arrow&. Tis "atient was treate! '(covere! stenting of te !efect in te gastro!uo!enalarter(
7/21/2019 Imaging Of Acute Pancreatitis
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onclusion
Imaging3 "re!ominantl( /T3 "la(s acentral role in te management of "atientswit acute "ancreatitis were assessmenton clinical groun!s alone can 'e etremel(
!i@cult.