Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2013; 19(30): 4907-4916
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4907
Pancreatitis in patients with pancreas divisum: Imaging features at MRI and MRCP
Deng-Bin Wang, Jinxing Yu, Ann S Fulcher, Mary A Turner
Deng-Bin Wang, Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Jinxing Yu, Ann S Fulcher, Mary A Turner, Department of Radiology, Virginia Commonwealth University, Medical College of Virginia, Richmond, VA 23298-0615, United States
Author contributions: Wang DB and Yu J performed the data acquisition, interpretation, and analysis; Wang DB, Yu J and Fulcher AS revised the manuscript; Wang DB, Yu J, Fulcher AS and Turner MA designed the study and wrote the manuscript.
Supported by National Natural Science Foundation of China, No. 81171389; Key Basic Research Project of Shanghai Municipal Science and Technology Commission, No. 12JC1406500
Correspondence to: Deng-Bin Wang, MD, PhD, Chair and Professor, Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China. dbwang8@aliyun.com
Telephone: +86-21-25078999 Fax: +86-21-65030840
Received: April 23, 2013
Revised: June 13, 2013
Accepted: June 28, 2013
Published online: August 14, 2013

AIM: To determine the magnetic resonance cholangiopancreatography (MRCP) and magnetic resonance imaging (MRI) features of pancreatitis with pancreas divisum (PD) and the differences vs pancreatitis without divisum.

METHODS: Institutional review board approval was obtained and the informed consent requirement was waived for this HIPAA-compliant study. During one year period, 1439 consecutive patients underwent successful MRCP without injection of secretin and abdominal MRI studies for a variety of clinical indications using a 1.5 T magnetic resonance scanner. Two experienced radiologists retrospectively reviewed all the studies in consensus. Disputes were resolved via consultation with a third experienced radiologist. The assessment included presence and the imaging findings of PD, pancreatitis, and distribution of abnormalities. The pancreatitis with divisum constituted the study group while the pancreatitis without divisum served as the control group. MRCP and MRI findings were correlated with final diagnosis. Fisher exact tests and Pearson × 2 tests were performed.

RESULTS: Pancreatitis was demonstrated at MRCP and MRI in 173 cases (38 cases with and 135 cases without divisum) among the 1439 consecutive cases. The recurrent acute pancreatitis accounted for 55.26% (21 of 38) in pancreatitis patients associated with PD, which was higher than 6.67% (9 of 135) in the control group, whereas the chronic pancreatitis was a dominant type in the control group (85.19%, 115 of 135) when compared to the study group (42.11%, 16 of 38) (χ2 = 40.494, P < 0.0001). In cases of pancreatitis with PD, the dorsal pancreatitis accounted for a much higher percentage than that in pancreatitis without PD (17 of 38, 44.74% vs 30 of 135, 22.22%) (χ2 = 7.257, P < 0.05).

CONCLUSION: MRCP and MRI can depict the features of pancreatitis associated with divisum. Recurrent acute pancreatitis and isolated dorsal involvement are more common in patients with divisum.

Keywords: Pancreas divisum, Pancreatitis, Diagnosis, Magnetic resonance imaging, Magnetic resonance cholangiopancreatography

Core tip: We reviewed 1439 cases of abdominal magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). There were 122 cases of pancreas divisum (PD) and 38 of them were diagnosed as pancreatitis. The pancreatitis associated with PD was usually distributed in dorsal pancreas and presented as recurrent acute type. MRCP in combination with MRI can accurately detect ductal and parenchymal abnormalities of pancreas. Therefore, MRCP and MRI should be referred to as primary diagnostic tools for pancreatitis with PD whereas endoscopic retrograde cholangiopancreatography can be reserved for those who require therapeutic interventions.