Chronic Pancreatitis Imaging Clinical Practice Guidelines (2018)

Working Group for the International (IAP, APA, JPS, EPC) Consensus Guidelines for Chronic Pancreatitis

Reviewed and summarized by Medscape editors

October 23, 2018

The clinical practice guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis were released in October 2018 by the Working Group for the International Consensus Guidelines for Chronic Pancreatitis.[1]

Computed tomography (CT) is often the most appropriate initial imaging modality to evaluate suspected chronic pancreatitis (CP); it depicts most of the changes in pancreatic morphology.

CT is also indicated to exclude other potential intra-abdominal pathologies that present with symptoms similar to those of chronic pancreatitis, but CT cannot exclude a diagnosis of CP and cannot exclusively diagnose early or mild CP.

Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) are superior and are indicated especially in patients in whom no specific pathologic changes are seen on CT.

Secretin-stimulated MRCP is more accurate than standard MRCP to identify subtle ductal changes. Secretin-stimulated MRCP should be performed after a negative MRCP if there is still clinical suspicion of CP.

Secretin-stimulated MRCP can provide assessment of exocrine function and ductal compliance.

Endoscopic ultrasound (EUS) can also be used to diagnose parenchymal and ductal changes mainly during the early stage of CP.

There are no known validated radiologic severity scoring systems for CP, but a modified Cambridge Classification has been used for MRCP.

A new and validated radiologic CP severity scoring system is needed that is based on imaging criteria (CT and/or MRI), including glandular volume loss, ductal changes, parenchymal calcifications, and parenchymal fibrosis.

For more information, please go to Chronic Pancreatitis Imaging.

For more Clinical Practice Guidelines, please go to Guidelines.

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