Acute Pancreatitis: Interobserver Agreement and Correlation of CT and MR Cholangiopancreatography with Outcome1
Robin Lecesne, MD,
Patrice Taourel, MD,
Patrice M. Bret, MD,
Mostafa Atri, MD and
Caroline Reinhold, MD
1 From the Department of Radiology, Montreal General Hospital, McGill University, Montreal, Canada. Received , 1998; revision requested ; revision received ; accepted , 1999. Supported in part by the French Society of Radiology. Address reprint requests to P.M.B., Department of Radiology, Toronto Hospital, General Division, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4.
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Figure 1a. Endoscopic retrograde cholangiopancreatography–induced pancreatitis. (a) Contrast-enhanced CT image demonstrates acute fluid collections (arrows) within the transverse mesocolon. (b) Fat-suppressed T1-weighted SE (sharp windows) MR image (500/10) shows hyperintense acute fluid collections within the transverse mesocolon (arrows) but also within both the right and left retropancreatic spaces (arrowheads). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (arrowheads) are heterogeneous (hyper- and hypointense) and better depicted. (d) Contrast-enhanced fat-suppressed T1-weighted SE MR image (500/10) depicts acute fluid collections (arrowheads).
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Figure 1b. Endoscopic retrograde cholangiopancreatography–induced pancreatitis. (a) Contrast-enhanced CT image demonstrates acute fluid collections (arrows) within the transverse mesocolon. (b) Fat-suppressed T1-weighted SE (sharp windows) MR image (500/10) shows hyperintense acute fluid collections within the transverse mesocolon (arrows) but also within both the right and left retropancreatic spaces (arrowheads). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (arrowheads) are heterogeneous (hyper- and hypointense) and better depicted. (d) Contrast-enhanced fat-suppressed T1-weighted SE MR image (500/10) depicts acute fluid collections (arrowheads).
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Figure 1c. Endoscopic retrograde cholangiopancreatography–induced pancreatitis. (a) Contrast-enhanced CT image demonstrates acute fluid collections (arrows) within the transverse mesocolon. (b) Fat-suppressed T1-weighted SE (sharp windows) MR image (500/10) shows hyperintense acute fluid collections within the transverse mesocolon (arrows) but also within both the right and left retropancreatic spaces (arrowheads). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (arrowheads) are heterogeneous (hyper- and hypointense) and better depicted. (d) Contrast-enhanced fat-suppressed T1-weighted SE MR image (500/10) depicts acute fluid collections (arrowheads).
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Figure 1d. Endoscopic retrograde cholangiopancreatography–induced pancreatitis. (a) Contrast-enhanced CT image demonstrates acute fluid collections (arrows) within the transverse mesocolon. (b) Fat-suppressed T1-weighted SE (sharp windows) MR image (500/10) shows hyperintense acute fluid collections within the transverse mesocolon (arrows) but also within both the right and left retropancreatic spaces (arrowheads). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (arrowheads) are heterogeneous (hyper- and hypointense) and better depicted. (d) Contrast-enhanced fat-suppressed T1-weighted SE MR image (500/10) depicts acute fluid collections (arrowheads).
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Figure 2a. Acute fluid collection in a patient with grade E postlaparoscopic cholecystectomy pancreatitis. (a) Contrast-enhanced CT image shows a homogeneous acute collection (arrow) surrounded by a well-defined enhancing rim (arrowheads) within the head of the pancreas. (b) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (white arrowheads) are seen better within the root of the mesentery. A collection (arrow) appears heterogeneous and predominantly solid (because of blood clots) and is surrounded by a hypointense rim (black arrowheads).
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Figure 2b. Acute fluid collection in a patient with grade E postlaparoscopic cholecystectomy pancreatitis. (a) Contrast-enhanced CT image shows a homogeneous acute collection (arrow) surrounded by a well-defined enhancing rim (arrowheads) within the head of the pancreas. (b) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), acute fluid collections (white arrowheads) are seen better within the root of the mesentery. A collection (arrow) appears heterogeneous and predominantly solid (because of blood clots) and is surrounded by a hypointense rim (black arrowheads).
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Figure 3a. Gallstone pancreatitis. (a) On the contrast-enhanced CT image (with a score of 6 for necrosis), more than half of the pancreas (arrows) does not enhance. Peripancreatic acute fluid collections (arrowheads) are seen. (b) Similar nonenhancing areas (arrows) are observed on the contrast-enhanced fat-suppressed T1-weighted gradient-echo MR image (120/4.2; 70° flip angle). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), areas of necrosis (arrows) appear as sharply defined areas of increased signal intensity. A gallstone (small arrowhead) and acute fluid collections (large arrowheads) are more conspicuous.
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Figure 3b. Gallstone pancreatitis. (a) On the contrast-enhanced CT image (with a score of 6 for necrosis), more than half of the pancreas (arrows) does not enhance. Peripancreatic acute fluid collections (arrowheads) are seen. (b) Similar nonenhancing areas (arrows) are observed on the contrast-enhanced fat-suppressed T1-weighted gradient-echo MR image (120/4.2; 70° flip angle). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), areas of necrosis (arrows) appear as sharply defined areas of increased signal intensity. A gallstone (small arrowhead) and acute fluid collections (large arrowheads) are more conspicuous.
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Figure 3c. Gallstone pancreatitis. (a) On the contrast-enhanced CT image (with a score of 6 for necrosis), more than half of the pancreas (arrows) does not enhance. Peripancreatic acute fluid collections (arrowheads) are seen. (b) Similar nonenhancing areas (arrows) are observed on the contrast-enhanced fat-suppressed T1-weighted gradient-echo MR image (120/4.2; 70° flip angle). (c) On the fat-suppressed T2-weighted fast SE MR image (4,000/112 [effective]), areas of necrosis (arrows) appear as sharply defined areas of increased signal intensity. A gallstone (small arrowhead) and acute fluid collections (large arrowheads) are more conspicuous.
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Figure 4a. Hypercalcemia-induced pancreatitis. There was a discrepancy between contrast-enhanced CT and nonenhanced MR cholangiopancreatographic findings in staging the severity of the inflammatory process. (a) On the contrast-enhanced CT image, haziness and streaky areas of low attenuation representing inflammatory changes (arrowheads) in the peripancreatic fat are noted and determined to be grade C. (b) On the T1-weighted SE MR image (400/10), these abnormalities appear as strands (arrowheads) within peripancreatic fat and can be scored as grade C. (c) On the fat-suppressed T1-weighted SE MR image (500/10), hemorrhagic-like components (arrows) were scored as grade D and are well depicted within peripancreatic spaces.
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Figure 4b. Hypercalcemia-induced pancreatitis. There was a discrepancy between contrast-enhanced CT and nonenhanced MR cholangiopancreatographic findings in staging the severity of the inflammatory process. (a) On the contrast-enhanced CT image, haziness and streaky areas of low attenuation representing inflammatory changes (arrowheads) in the peripancreatic fat are noted and determined to be grade C. (b) On the T1-weighted SE MR image (400/10), these abnormalities appear as strands (arrowheads) within peripancreatic fat and can be scored as grade C. (c) On the fat-suppressed T1-weighted SE MR image (500/10), hemorrhagic-like components (arrows) were scored as grade D and are well depicted within peripancreatic spaces.
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Figure 4c. Hypercalcemia-induced pancreatitis. There was a discrepancy between contrast-enhanced CT and nonenhanced MR cholangiopancreatographic findings in staging the severity of the inflammatory process. (a) On the contrast-enhanced CT image, haziness and streaky areas of low attenuation representing inflammatory changes (arrowheads) in the peripancreatic fat are noted and determined to be grade C. (b) On the T1-weighted SE MR image (400/10), these abnormalities appear as strands (arrowheads) within peripancreatic fat and can be scored as grade C. (c) On the fat-suppressed T1-weighted SE MR image (500/10), hemorrhagic-like components (arrows) were scored as grade D and are well depicted within peripancreatic spaces.
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Copyright © 1999 by the Radiological Society of North America.
