MRI has an added advantage for noninvasive evaluation of the pancreatic parenchyma, biliary and pancreatic ducts, adjacent soft tissues, vascular structures, and composition of AP-associated fluid collections in a single examination [17,19,20]. However, MRI abdomen without and with IV contrast with MRCP does not provide coverage and adequate evaluation of the bowel to assess an alternative diagnosis of bowel ischemia, perforation, etc. US Abdomen US is often the first-line imaging modality in most centers for the evaluation of acute abdominal pain because it is reproducible and can be accomplished at the bedside [15]. Approximately 20% of the time, the pancreas demonstrates features of AP on US, including diffuse glandular enlargement, hypoechoic echotexture of the pancreas consistent with edema, and ascites. US can also be useful for the diagnosis of an alternative etiology of abdominal pain, such as acute cholecystitis. However, US is limited by overlying bowel gas or adynamic ileus in the majority of patients with AP [15]. The primary use of US in patients with AP is to identify gallstones or biliary ductal dilatation. US Abdomen with IV Contrast CEUS is emerging as a potential option for focal evaluation of the pancreas, and it is well suited to the evaluation of perfusion with its use of intravascular contrast agents [15]. However, the use of microbubble contrast for this indication is currently not approved by the FDA, so its use would be considered off-label. Furthermore, CEUS is a focused examination, and in patients with an equivocal presentation of pancreatitis for whom diagnoses other than pancreatitis may be possible, a focused examination may be inadequate. Finally, similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. Acute Pancreatitis Even in cases of severe AP, clinical scoring methods are used to direct patient care independent of imaging in the early phase.
Acute Pancreatitis. MRI has an added advantage for noninvasive evaluation of the pancreatic parenchyma, biliary and pancreatic ducts, adjacent soft tissues, vascular structures, and composition of AP-associated fluid collections in a single examination [17,19,20]. However, MRI abdomen without and with IV contrast with MRCP does not provide coverage and adequate evaluation of the bowel to assess an alternative diagnosis of bowel ischemia, perforation, etc. US Abdomen US is often the first-line imaging modality in most centers for the evaluation of acute abdominal pain because it is reproducible and can be accomplished at the bedside [15]. Approximately 20% of the time, the pancreas demonstrates features of AP on US, including diffuse glandular enlargement, hypoechoic echotexture of the pancreas consistent with edema, and ascites. US can also be useful for the diagnosis of an alternative etiology of abdominal pain, such as acute cholecystitis. However, US is limited by overlying bowel gas or adynamic ileus in the majority of patients with AP [15]. The primary use of US in patients with AP is to identify gallstones or biliary ductal dilatation. US Abdomen with IV Contrast CEUS is emerging as a potential option for focal evaluation of the pancreas, and it is well suited to the evaluation of perfusion with its use of intravascular contrast agents [15]. However, the use of microbubble contrast for this indication is currently not approved by the FDA, so its use would be considered off-label. Furthermore, CEUS is a focused examination, and in patients with an equivocal presentation of pancreatitis for whom diagnoses other than pancreatitis may be possible, a focused examination may be inadequate. Finally, similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. Acute Pancreatitis Even in cases of severe AP, clinical scoring methods are used to direct patient care independent of imaging in the early phase.