Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 541

Radiologic evaluation has generally superseded function studies in the diagnosis of chronic pancreatitis. Other than the rarely‐used abdominal X‐ray, abdominal ultrasound is the least expensive and most widely available modality for assessing the pancreas; however, the sensitivity of ultrasound for detecting chronic pancreatitis changes is less than that of CT or MRCP. In about two‐thirds of chronic patients, ultrasonography may show swelling of the gland or duct dilatation, but abdominal ultrasound may not be able to view the entire pancreas because of intervening bowel gas.

CT scanning provides similar information and is more sensitive in detecting parenchymal atrophy, ductal dilation, and calcifications, especially in advanced disease. Compared to other imaging modalities, MRCP gives the most detailed visual of pancreatic ductal anatomy, such as filling defects, main and side branch duct dilations, and irregularity of the main pancreatic duct. Administration of IV secretin during MRCP can provide data on duct compliance and even pancreatic flow, which may be helpful surrogates for pancreatic exocrine function, thus enhancing the sensitivity of detecting early chronic pancreatitis.²⁰

Endoscopic ultrasound (EUS) is another diagnostic modality that has gained support in diagnosing early chronic pancreatitis. It also evaluates parenchymal and ductal changes, utilizing a variety of EUS imaging criteria. However, there is a lack of standardization regarding EUS scoring tools for chronic pancreatitis, along with significant inter‐operator interpretation variance.

When chronic pancreatitis is suspected, our preference is to use CT or MRCP as the first‐line imaging modality, depending on local preference and experience.