The Importance of Structural Changes and Imaging in Chronic Pancreatitis

Abstract

Background: Chronic pancreatitis (CP) is diagnosed using combinations of symptoms, patient history, pancreatic function tests, and imaging. Imaging is also important in follow-up, for instance, if complications are suspected.

Aims: The overall objective was to evaluate the importance of diagnostic imaging modalities and different structural pancreatic changes in CP. In the first study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) scores, and in the second study, we aimed to compare the diagnostic accuracy of CT and ultrasound (US). In the third study, we aimed to explore the associations between key structural pancreatic changes and common complications related to CP.

Material and methods: Using a local database with registrations on patients with suspected CP, we evaluated the diagnostic accuracy of CT (n = 118). In patients who had been examined with CT and US (n = 73), we compared diagnostic performance of CT versus US. Using data registrations from 959 patients with CP included in an international multicenter database, we performed multiple logistic regression analyses to assess the relationships between structural pancreatic changes and clinical complications (pancreatic exocrine insufficiency, diabetes, underweight, and pain).

Results: For CT, we found sensitivities ranging from 63% to 72% and specificities from 75% to 91%. US had sensitivities between 64% and 72% and specificity of 85%. The differences between CT and US were not statistically significant. Patients with ductal obstruction, ≥15 calcifications, pancreatic atrophy, or parenchymal changes involving the entire pancreas were more likely to have CP related complications.

Conclusions and consequences: CT and US had similar, moderate diagnostic accuracy for CP. Our findings point to the importance of a multimodal workup and the weaknesses in the current imaging scoring systems. Structural imaging changes that are associated to complications may be used in the development of severity scoring systems. If these structural changes are detected in CP patients, closer monitoring for the development of complications is warranted.