MRI abdomen without IV contrast with MRCP provides more definitive evaluation of the contents of peripancreatic fluid collection and pancreatic ductal integrity when compared with CT. Limitations of MRI include motion artifacts that are due to longer scan times (especially in acutely ill patients who are unable to hold still) and decreased sensitivity for the detection of gas bubbles for imaging identification of infection. US Abdomen Traditional grayscale US is limited in the assessment of necrotizing pancreatitis because it does not allow for the assessment of parenchymal perfusion. Transabdominal US is used for characterization of peripancreatic fluid collections by evaluating for internal, necrotic debris. It is particularly helpful for guiding diagnostic and Acute Pancreatitis therapeutic intervention for large pseudocysts; however, it is limited for the identification of small collections [21]. Gas bubbles within pancreatic and peripancreatic fluid collections may be seen on transabdominal US; however, CT is more commonly used for the imaging diagnosis of infection. US Abdomen with IV Contrast CEUS is emerging as a potential option for focal evaluation of the pancreas. CEUS is well suited to the evaluation of pancreatic parenchymal perfusion, given its use of intravascular contrast agents [15]. Although CEUS can also be used to evaluate complications of pancreatitis, such as splenic artery aneurysm [28], evaluation of local complications and extrapancreatic necrosis may be limited by the focal nature of this examination. Similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. US Duplex Doppler Abdomen Color Doppler US may be combined with traditional grayscale US for evaluation of vascular complications, such as arterial pseudoaneurysms or thrombosis of the portal venous system. Variant 5: Known necrotizing pancreatitis.
Acute Pancreatitis. MRI abdomen without IV contrast with MRCP provides more definitive evaluation of the contents of peripancreatic fluid collection and pancreatic ductal integrity when compared with CT. Limitations of MRI include motion artifacts that are due to longer scan times (especially in acutely ill patients who are unable to hold still) and decreased sensitivity for the detection of gas bubbles for imaging identification of infection. US Abdomen Traditional grayscale US is limited in the assessment of necrotizing pancreatitis because it does not allow for the assessment of parenchymal perfusion. Transabdominal US is used for characterization of peripancreatic fluid collections by evaluating for internal, necrotic debris. It is particularly helpful for guiding diagnostic and Acute Pancreatitis therapeutic intervention for large pseudocysts; however, it is limited for the identification of small collections [21]. Gas bubbles within pancreatic and peripancreatic fluid collections may be seen on transabdominal US; however, CT is more commonly used for the imaging diagnosis of infection. US Abdomen with IV Contrast CEUS is emerging as a potential option for focal evaluation of the pancreas. CEUS is well suited to the evaluation of pancreatic parenchymal perfusion, given its use of intravascular contrast agents [15]. Although CEUS can also be used to evaluate complications of pancreatitis, such as splenic artery aneurysm [28], evaluation of local complications and extrapancreatic necrosis may be limited by the focal nature of this examination. Similar to grayscale US, CEUS is limited by bowel gas, which can be particularly problematic in patients with AP and frequently associated paralytic ileus. US Duplex Doppler Abdomen Color Doppler US may be combined with traditional grayscale US for evaluation of vascular complications, such as arterial pseudoaneurysms or thrombosis of the portal venous system. Variant 5: Known necrotizing pancreatitis.