Pancreatic Disorders & Therapy
Open Access

MRI In-Depth Assessment and Therapeutic Navigation in Acute Recurrent Pancreatitis: A Comprehensive Analytical Approach

Nicolà de Pretis^{* *}Correspondence: Nicolà de Pretis, Department of Endocrinology, University of Stellenbosch, Stellenbosch, South Africa, Email:

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Description

Acute Recurrent Pancreatitis (ARP) is a challenging clinical entity characterized by repeated episodes of acute pancreatic inflammation interspersed with periods of remission. Magnetic Resonance Imaging (MRI) [1], plays a pivotal role in the diagnosis and management of ARP, offering detailed anatomical visualization, assessment of pancreatic morphology, and identification of predisposing factors. This article provides a comprehensive overview of the utility of MRI in the evaluation of ARP, encompassing imaging protocols, radiological findings, and therapeutic implications.

Pathophysiology of acute recurrent pancreatitis

A Molecular Perspective ARP arises from a complex interplay of genetic, environmental, and metabolic factors, leading to recurrent bouts of pancreatic injury and inflammation [2]. Genetic predisposition, including mutations in genes encoding for digestive enzymes (e.g., PRSS1, SPINK1) and ion channels e.g., Cystic Fibrosis Transmembrane Conductance Regulator (CFTR), predisposes individuals to ARP by impairing pancreatic function and predisposing the pancreas to injury [3]. Environmental triggers such as alcohol consumption, gallstones, and medication use can precipitate acute pancreatitis episodes, exacerbating the underlying pathology.

Diagnostic challenges in acute recurrent pancreatitis role of MRI

The diagnosis of ARP poses significant challenges due to its variable clinical presentation and overlapping features with chronic pancreatitis. Conventional imaging modalities such as Computed Tomography (CT) [4] and ultrasound may fail to detect subtle pancreatic abnormalities or assess disease progression accurately. In contrast, MRI offers superior soft tissue contrast, multiplanar imaging capabilities, and functional information without ionizing radiation exposure, making it an invaluable tool in the evaluation of ARP.

MRI protocols for acute recurrent pancreatitis

MRI protocols for ARP typically include multipara metric sequences tailored to assess pancreatic morphology, parenchymal enhancement patterns, and pancreatic ductal anatomy [5]. T1- weighted imaging provides excellent anatomical detail and facilitates the detection of pancreatic calcifications and focal lesions. T2-weighted imaging highlights fluid collections, edema, and inflammation within the pancreas, aiding in the diagnosis and characterization of acute pancreatitis episodes [6]. Additionally, Magnetic Resonance Cholangio Pancreatography (MRCP) enables visualization of the pancreatic ductal system, identifying ductal strictures, dilatations, or anomalies associated with ARP [7].

Radiological findings in acute recurrent pancreatitis

MRI findings in ARP encompass a spectrum of morphological changes, including pancreatic edema, per pancreatic fluid collections, and focal parenchymal abnormalities [8]. Dynamic contrast-enhanced MRI allows for the assessment of pancreatic perfusion and the identification of focal inflammatory changes or pseudo cysts [9]. Furthermore, MRCP delineates ductal irregularities, including strictures, calculi, and ductal ectasia, aiding in the differentiation of ARP from other pancreatic disorders.

Therapeutic implications of MRI in acute recurrent pancreatitis

MRI findings guide therapeutic decision-making in ARP, facilitating risk stratification, treatment planning, and monitoring of disease progression [10]. Identification of predisposing factors such as pancreatic ductal strictures or calculi may prompt endoscopic interventions, including Endoscopic Retrograde Cholangio Pancreatography (ERCP) with ductal stenting or stone extraction. Additionally, MRI surveillance enables early detection of disease complications, including pancreatic pseudo cysts, necrosis, or malignancy, necessitating timely intervention to prevent adverse outcomes.

Conclusion

MRI serves as a cornerstone in the diagnosis and management of acute recurrent pancreatitis, offering unparalleled anatomical detail, functional assessment, and therapeutic guidance. By leveraging advanced imaging techniques and multidisciplinary collaboration, healthcare providers can optimize patient care, improve outcomes, and mitigate the burden of ARP on affected individuals.

References

1. Murati MA, Ames JC, Trout AT, Dietz KR. Magnetic resonance imaging glossary of findings of pediatric pancreatitis and the revised Atlanta classification. Pediatr Radiol. 2022;52(2):189-199.

   [Crossref] [Google Scholar] [PubMed]

2. McCleary BM, Trout AT, Fei L, Sun Q, Serai SD, Dillman JR, et al. Healthy pancreatic parenchymal volume and its relationship to exocrine function. Pediatric Radiology. 2020; 50:684-688.

   [Crossref] [Google Scholar] [PubMed]

3. Szücs Á, Marjai T, Szentesi A, Farkas N, Párniczky A, Nagy G, et al. Chronic pancreatitis: multicentre prospective data collection and analysis by the hungarian pancreatic study group. PloS one. 2017;12(2): e0171420.

   [Crossref] [Google Scholar] [PubMed]

4. Hori Y, Vege SS, Chari ST, Gleeson FC, Levy MJ, Pearson RK. Classic chronic pancreatitis is associated with prior acute pancreatitis in only 50% of patients in a large single-institution study. Pancreatology. 2019;19(2):224-229.

   [Crossref] [Google Scholar] [PubMed]

5. Meczker Á, Mikó A, Gede N, Szentesi A, Párniczky A, Gódi S, et al. Retrospective matched-cohort analysis of acute pancreatitis induced by 5-aminosalicylic acid–derived drugs. Pancreas. 2019;48(4):488-495.

   [Crossref] [Google Scholar] [PubMed]

6. Wood BJ, Kruecker J, Abi-Jaoudeh N, Locklin JK, Levy E, Xu S, et al. Navigation systems for ablation. J Vasc Interv Radiol. 2010;21(8): S257-S263.

   [Crossref] [Google Scholar] [PubMed]

7. De Baere T, Deschamps F. New tumor ablation techniques for cancer treatment (microwave, electroporation). Diagnostic and interventional imaging. 2014;95(7-8):677-682.

   [Crossref] [Google Scholar] [PubMed]

8. Lipsman N, Schwartz ML, Huang Y, Lee L, Sankar T, Chapman M, Hynynen K, et al. MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study. Lancet Neurol. 2013;12(5):462-468.

   [Crossref] [Google Scholar] [PubMed]

9. Ritchie R, Collin J, Coussios C, Leslie T. Attenuation and de-focusing during high-intensity focused ultrasound therapy through peri-nephric fat. Ultrasound Med Biol. 2013;39(10):1785-1793.

   [Crossref] [Google Scholar] [PubMed]

10. Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging. 2017;98(6):483-489.

    [Crossref] [Google Scholar] [PubMed]