Abstract
Pancreatic fibrosis is the dominant reversible pathological change and diagnostic factor in early chronic pancreatitis, defined by a mechanistic approach proposed in 2016. Main guidelines for chronic pancreatitis were published by the American Pancreas Association in 2014, the Japanese Society of Gastroenterology in 2015, and United European Gastroenterology in 2017. All three sets of guidelines mentioned that the staging of chronic pancreatitis is important but challenging. There are various image modalities for the non-histologic diagnosis of pancreatic fibrosis: (1) shear wave elastography, such as an acoustic radiation force impulse with a cut-off value of 1.4 m/s; (2) strain elastography using grades of strain; (3) endoscopic ultrasonography using the Rosemont criteria or endoscopic ultrasound criteria for early chronic pancreatitis proposed by the Japan Pancreas Society; (4) computed tomography using the Hounsfield scale or number of micro-calcifications; and (5) magnetic resonance imaging using the apparent diffusion coefficient and the T1w flash and T2w HASTE sequences. The clinical applications are to (1) evaluate pancreatic tumors and inflammatory disease; (2) monitor dyspepsia with early chronic pancreatitis; (3) monitor individuals with a high risk of pancreatic cancer; (4) analyze a fatty pancreas with fibrosis; (5) predict a fistula after pancreatic surgery; and (6) predict outcomes for chronic pancreatitis or pancreatic cancer. The selection of tools will be dependent on the clinical scenario. Conclusion: There are various modalities for the non-histologic diagnosis of pancreatic fibrosis. The selection of the optimal device will be dependent on the clinical scenario.
Highlights
Division Gastroenterology, Department of Internal Medicine, Far-Eastern Memorial Hospital, No.21, Sec. 2, Graduate Institute of Applied Science and Engineering, College of Science and Engineering, No.510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City 24205, Taiwan
This study found that a predictor is calcification, especially when the number is > 10 [19]
It is well known that endoscopic ultrasound (EUS) can detect subtle parenchymal morphologic changes of pancreatic fibrosis in the early stage of chronic pancreatitis
Summary
Diagnostics 2020, 10, 87 parenchyma can be an early stage surrogate for chronic pancreatitis. Endoscopic ultrasound (EUS) coupled with elastography would currently be the most sensitive diagnostic modality for detecting pancreatic parenchymal fibrosis. The non-histologic diagnosis of pancreatic fibrosis is an image-based method using different bio-physical mechanisms, including ultrasound elastography, computed tomography (CT), and magnetic resonance imaging (MRI) [14].
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