Therefore, when imaging is considered for evaluation of symptomatic organized pancreatic or peripancreatic fluid collections, particularly when intervention is contemplated, MRI should be considered in place or as a follow-up to a contrast-enhanced CT [31]. MRI abdomen without and with IV contrast with MRCP is also 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 Acute Pancreatitis downstream pancreatic duct. 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. MRI with MRCP provides more definitive evaluation of pancreatic ductal integrity when compared with CT. Visualization of the pancreatic duct may be improved by using a synthetic analog of the hormone secretin, which is sometimes administered to augment the MRCP. Furthermore, although ERCP is considered the gold standard for detection of pancreatic ductal disruption, MRI abdomen without and with IV contrast with MRCP has the advantage of being able to evaluate both the main pancreatic duct and the pancreatic parenchyma simultaneously, as compared with combining CT abdomen and pelvis without and with IV contrast with ERCP. MRI abdomen without and with IV contrast with MRCP also avoids the potential complications associated with ERCP, such as post-ERCP pancreatitis [26,32].
Acute Pancreatitis. Therefore, when imaging is considered for evaluation of symptomatic organized pancreatic or peripancreatic fluid collections, particularly when intervention is contemplated, MRI should be considered in place or as a follow-up to a contrast-enhanced CT [31]. MRI abdomen without and with IV contrast with MRCP is also 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 Acute Pancreatitis downstream pancreatic duct. 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. MRI with MRCP provides more definitive evaluation of pancreatic ductal integrity when compared with CT. Visualization of the pancreatic duct may be improved by using a synthetic analog of the hormone secretin, which is sometimes administered to augment the MRCP. Furthermore, although ERCP is considered the gold standard for detection of pancreatic ductal disruption, MRI abdomen without and with IV contrast with MRCP has the advantage of being able to evaluate both the main pancreatic duct and the pancreatic parenchyma simultaneously, as compared with combining CT abdomen and pelvis without and with IV contrast with ERCP. MRI abdomen without and with IV contrast with MRCP also avoids the potential complications associated with ERCP, such as post-ERCP pancreatitis [26,32].