Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2023; 15(2): 42-55
Published online Feb 28, 2023. doi: 10.4329/wjr.v15.i2.42
Imaging of paraduodenal pancreatitis: A systematic review
Matteo Bonatti, Nicolò De Pretis, Giulia A Zamboni, Alessandro Brillo, Stefano Francesco Crinò, Riccardo Valletta, Fabio Lombardo, Giancarlo Mansueto, Luca Frulloni
Matteo Bonatti, Riccardo Valletta, Department of Radiology, Ospedale Centrale di Bolzano, Bolzano 39100, Italy
Nicolò De Pretis, Alessandro Brillo, Luca Frulloni, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital of Verona, Verona 37134, Italy
Giulia A Zamboni, Giancarlo Mansueto, Department of Diagnostics and Public Health, Radiology Section, Policlinico GB Rossi, University of Verona, Verona 37134, Verona, Italy
Stefano Francesco Crinò, Department of Medicine, University of Verona, Verona 37134, Italy
Fabio Lombardo, Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
Author contributions: Bonatti M, De Pretis N and Valletta R designed the research; Bonatti M, De Pretis N, Crinò SF and Brillo A performed the research; Bonatti M, De Pretis N and Lombardo F analyzed the data; Bonatti M, Zamboni GA, Lombardo F, Mansueto G and Frulloni L wrote the paper; All authors approved the final version of the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Matteo Bonatti, MD, Adjunct Professor, Doctor, Department of Radiology, Ospedale Centrale di Bolzano, Via Boehler 5, 39100 Bolzano, Italy. matteo.bonatti@sabes.it
Received: September 28, 2022
Peer-review started: September 28, 2022
First decision: October 17, 2022
Revised: October 24, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: February 28, 2023
Abstract
BACKGROUND

Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with pancreatic cancer. There are two main histological variants of PP, the cystic and the solid, with slightly different imaging appearances. Moreover, imaging findings in PP may change over time because of disease progression and/or as an effect of its risk factors exposition, namely alcohol intake and smoking.

AIM

To describe multimodality imaging findings in patients affected by PP to help clinicians in the differential diagnosis with pancreatic cancer.

METHODS

The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses 2009 guidelines. A Literature search was performed on PubMed, Embase and Cochrane Library using (groove pancreatitis [Title/Abstract]) OR (PP [Title/Abstract]) as key words. A total of 593 articles were considered for inclusion. After eliminating duplicates, and title and abstract screening, 53 full-text articles were assessed for eligibility. Eligibility criteria were: Original studies including 8 or more patients, fully written in English, describing imaging findings in PP, with pathological confirmation or clinical-radiological follow-up as the gold standard. Finally, 14 studies were included in our systematic review.

RESULTS

Computed tomography (CT) findings were described in 292 patients, magnetic resonance imaging (MRI) findings in 231 and endoscopic ultrasound (EUS) findings in 115. Duodenal wall thickening was observed in 88.8% of the cases: Detection rate was 96.5% at EUS, 91.0% at MRI and 84.1% at CT. Second duodenal portion increased enhancement was recognizable in 76.3% of the cases: Detection rate was 84.4% at MRI and 72.1% at CT. Cysts within the duodenal wall were detected in 82.6% of the cases: Detection rate was 94.4% at EUS, 81.9% at MRI and 75.7% at CT. A solid mass in the groove region was described in 40.9% of the cases; in 78.3% of the cases, it showed patchy enhancement in the portal venous phase, and in 100% appeared iso/hyperintense during delayed phase imaging. Only 3.6% of the lesions showed restricted diffusion. The prevalence of radiological signs of chronic obstructive pancreatitis, namely main pancreatic duct dilatation, pancreatic calcifications, and pancreatic cysts, was extremely variable in the different articles.

CONCLUSION

PP has peculiar imaging findings. MRI is the best radiological imaging modality for diagnosing PP, but EUS is more accurate than MRI in depicting duodenal wall alterations.

Keywords: Pancreatitis, Paraduodenal pancreatitis, Diagnostic imaging, Computed tomography, Magnetic resonance imaging, Endoscopic ultrasound

Core Tip: Paraduodenal pancreatitis (PP) represents a diagnostic challenge, especially in non-referral centers, given its potential imaging overlap with neoplastic processes, namely pancreatic and duodenal carcinoma. Numerous articles show imaging features of PP, but most of them are represented by case reports or reviews with poor scientific background. This systematic review describes the multimodality imaging features (computed tomography, magnetic resonance imaging and endoscopic ultrasound) of PP according to original research articles with pathologic samples and or clinical-radiological follow-up as the gold standard.