Although, it cannot assess the presence of rim enhancement, which adds to the specificity of the diagnosis of an infected collection, in the presence of clinical concern, CT abdomen and pelvis without IV contrast can help preprocedural planning. Smaller fluid collections may sometimes be difficult to distinguish from adjacent fluid-filled bowel loops. CT abdomen and pelvis without and with IV contrast does not add to the diagnostic information. MRI Abdomen MRI abdomen without and with IV contrast with MRCP is comparable to CT abdomen and pelvis with IV contrast for the diagnosis of necrotizing pancreatitis [21]. Pancreatic necrosis is identified as areas of low signal compared with the normal increased signal of the pancreas on fat-saturated T1-weighted unenhanced images and as focal regions of nonenhancement with IV contrast. On T2-weighted images, necrosis can be low signal intensity or hyperintense when liquefied. Fluid-sensitive MRI sequences, including T2-weighted imaging and MRCP, are superior to CT for depiction of necrotic debris within fluid collections [21,26], and MRI with MRCP is well suited for evaluation of pancreatic duct disruption, which most commonly occurs as a complication of necrotizing pancreatitis [22]. Necrosis (typically of the central gland) may lead to an isolated, functional, upstream pancreatic segment that is not connected to the downstream pancreatic duct. Collections resulting from continued ductal secretions from viable pancreatic parenchyma in the area of disrupted duct typically fail to spontaneously resolve. Conservative treatment strategies or drainage will most likely fail in the setting of a disconnected pancreatic duct or lead to persistent pancreatic fistula formation; therefore, early diagnosis of this condition leads to reduced morbidity and may mitigate unnecessary drainage procedures.
Acute Pancreatitis. Although, it cannot assess the presence of rim enhancement, which adds to the specificity of the diagnosis of an infected collection, in the presence of clinical concern, CT abdomen and pelvis without IV contrast can help preprocedural planning. Smaller fluid collections may sometimes be difficult to distinguish from adjacent fluid-filled bowel loops. CT abdomen and pelvis without and with IV contrast does not add to the diagnostic information. MRI Abdomen MRI abdomen without and with IV contrast with MRCP is comparable to CT abdomen and pelvis with IV contrast for the diagnosis of necrotizing pancreatitis [21]. Pancreatic necrosis is identified as areas of low signal compared with the normal increased signal of the pancreas on fat-saturated T1-weighted unenhanced images and as focal regions of nonenhancement with IV contrast. On T2-weighted images, necrosis can be low signal intensity or hyperintense when liquefied. Fluid-sensitive MRI sequences, including T2-weighted imaging and MRCP, are superior to CT for depiction of necrotic debris within fluid collections [21,26], and MRI with MRCP is well suited for evaluation of pancreatic duct disruption, which most commonly occurs as a complication of necrotizing pancreatitis [22]. Necrosis (typically of the central gland) may lead to an isolated, functional, upstream pancreatic segment that is not connected to the downstream pancreatic duct. Collections resulting from continued ductal secretions from viable pancreatic parenchyma in the area of disrupted duct typically fail to spontaneously resolve. Conservative treatment strategies or drainage will most likely fail in the setting of a disconnected pancreatic duct or lead to persistent pancreatic fistula formation; therefore, early diagnosis of this condition leads to reduced morbidity and may mitigate unnecessary drainage procedures.