Calcifications In Chronic Pancreatitis Research Articles

Quantification of parenchymal calcifications in chronic pancreatitis: relation to atrophy, ductal changes, fibrosis and clinical parameters

Objectives: Parenchymal calcifications are considered a hallmark finding of chronic pancreatitis (CP), but little is known about its relation to the clinical presentation and other morphological features such as atrophy, fibrosis and ductal changes. The aim was to quantify the number and maximal size of parenchymal calcifications assessed on computed tomography (CT) and to explore the association with other CT and magnetic resonance imaging (MRI)–based pancreatic features and clinical parameters.Methods: A well-characterised cohort of 54 CP patients was included. CT measurements included number and size of parenchymal calcifications, gland diameter and ductal diameter. MRI measurements included gland volume, ductal diameter, fibrosis (diffusion) and fatty infiltration (Dixon). Clinical parameters included body mass index (BMI), CP duration and aetiology, M-ANNHEIM clinical stage, tobacco use, alcohol consumption, the presence of diabetes, faecal elastase, clinical pain score and quality of life.Results: There were no correlations between the number and size of parenchymal calcifications and any of the other morphological CT and MRI parameters (all p > .05), except for larger size of calcifications in patients with high number of calcifications (p < .001). The number of parenchymal calcifications was negatively correlated with BMI (r = −0.35, p = .0088). The number and size of parenchymal calcifications did not correlate with any of the other clinical parameters (all p > .2).Conclusion: Our findings could indicate the existence of parenchymal calcifications as an independent pathophysiological process involved in the development of CP.Translational impact: Quantifications of calcifications could, in combination with other imaging biomarkers, be a useful imaging marker relevant for characterising CP.

Parenchymal calcifications in chronic pancreatitis: quantitative assessment and its relation to atrophy, ductal changes, fibrosis and clinical presentation

Parenchymal calcifications in chronic pancreatitis: quantitative assessment and its relation to atrophy, ductal changes, fibrosis and clinical presentation

Investigation at the micrometer scale of pancreatic calcifications in chronic pancreatitis by μFTIR spectroscopy and field emission scanning electron microscopy

A set of pancreatic stones and surgical specimens with chronic pancreatitis from various etiologies has been investigated by Fourier Transform Infra-Red spectroscopy and field emission scanning electron microscopy in order to gather information regarding their chemical composition and their structural characteristics at the mesoscopic scale. These physicochemical data were compared to the medical data of the patients. Regarding the pancreatic stones, the complete set of data underlines the presence of the three calcium carbonate polymorphs as well as a great diversity on their spatial distribution (core versus surface), a wide range of protein content and the presence of other phases in a limited number of samples. These results suggest that very different mechanisms are involved in stone formation. Major results have been also obtained on pancreas tissues. Chemical diversity exists also for ectopic calcifications. The presence of CA and its amorphous precursor (ACCP) constitutes a real challenge for clinicians, such chemical compounds being associated to biological parameters far from those related to calcium carbonate.

Association between Smoking and the Progression of Computed Tomography Findings in Chronic Pancreatitis.

Background/AimsSmoking and alcohol intake are two well-known risk factors for chronic pancreatitis. However, there are few studies examining the association between smoking and changes in computed tomography (CT) findings in chronic pancreatitis. The authors evaluated associations between smoking, drinking and the progression of calcification on CT in chronic pancreatitis.MethodsIn this retrospective study, 59 patients with chronic pancreatitis who had undergone initial and follow-up CT between January 2002 and September 2010 were included. Progression of calcification among CT findings was compared according to the amount of alcohol intake and smoking.ResultsThe median duration of follow-up was 51.6 months (range, 17.1 to 112.7 months). At initial CT findings, there was pancreatic calcification in 35 patients (59.3%). In the follow-up CT, progression of calcification was observed in 37 patients (62.7%). Progression of calcification was more common in smokers according to the multivariate analysis (odds ratio [OR], 9.987; p=0.006). The amount of smoking was a significant predictor for progression of calcification in the multivariate analysis (OR, 6.051 in less than 1 pack per day smokers; OR, 36.562 in more than 1 pack per day smokers; p=0.008).ConclusionsContinued smoking accelerates pancreatic calcification, and the amount of smoking is associated with the progression of calcification in chronic pancreatitis.

Abdominal CT predictors of fibrosis in patients with chronic pancreatitis undergoing surgery

To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). • Parenchymal calcifications in chronic pancreatitis independently predict post-operative pain relief • Intraductal calculi and MPD dilation are not associated with post-operative pain relief • Better patient selection for pancreatic resection surgery in painful chronic pancreatitis.

IRM et maladies pancréatiques

Magnetic resonance (MR) imaging of the pancreas has undergone a major change because it can provide noninvasive images of the pancreatic ducts and the parenchyma. MR cholangiopancreatography (MRCP) enables detection of anatomic variants such as pancreas divisum. Although contrast material-enhanced CT is still considered the gold standard in acute pancreatitis and for the detection of calcifications in chronic pancreatitis, MR imaging and secretin-enhanced MRCP are useful in evaluating pseudocysts and pancreatic disruption. The role of MR is still debated in pancreatic neoplasms except the cystic lesions where MR imaging provides critical information regarding the lesion's content and a possible communication with the pancreatic ducts. MRCP and MR of the pancreas are also useful in identifying other pancreatic diseases such as lymphoplasmocytic pancreatitis and groove pancreatitis.

MR Imaging of the Pancreas: A Pictorial Tour

Magnetic resonance (MR) imaging of the pancreas has undergone a major change because of its capability of providing noninvasive images of the pancreatic ducts, cross-sectional images of the parenchyma analogous to computed tomography (CT) images, and angiographic depiction of blood vessels. Recent technical issues include the use of half-Fourier T2-weighted pulse sequences and the administration of secretin for MR cholangiopancreatography (MRCP). Secretin improves pancreatic duct and side-branch delineation and the detection of anatomic variants such as pancreas divisum. It allows monitoring of pancreatic flow dynamics and evaluation of pancreatic exocrine function. Although contrast material--enhanced CT is still considered the standard of reference in severe acute pancreatitis and for the detection of calcifications in chronic pancreatitis, in patients referred for suspicion of pancreatic disease or with recurrent acute pancreatitis, MR imaging and secretin-enhanced MRCP are useful after unenhanced CT suggests the cause of disease. In advanced inflammatory disease, MR imaging and secretin-enhanced MRCP are useful for planning surgery or therapeutic endoscopy and for follow-up studies after therapy. MR imaging in combination with secretin-enhanced MRCP and MR angiography is useful in identifying pancreatic malignancies and in establishing resectability.

Evolution and regression of pancreatic calcification in chronic pancreatitis: A prospective long-term study of 107 patients

Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis and develop in up to 90% of patients with alcoholic chronic pancreatitis in series with long-term results. We investigated the natural course of pancreatic calcification in a prospective longitudinal study over the past 23 yr. All patients were studied at regular intervals with particular regard to etiology, clinical findings, surgery, pancreatic function, and pancreatic calcification visible by x-ray (e.g., film series in three projections centered on the pancreas). We evaluated the findings of 107 patients with x-ray documentation of pancreatic calcification in at least three film series over a period of 4 yr or longer. Eighty-four patients had alcoholic chronic pancreatitis (group A) and 23 patients had nonalcoholic chronic pancreatitis (group B). Four hundred seventy-two film series of group A and one hundred forty-two film series of group B were reviewed independently by two expert teams. Both series were graded according to a score system in terms of intensity and distribution of pancreatic calcification (correlation of grading r = 0.91). The duration of calcification averaged 10 yr in group A and 12.6 yr in group B. Similar dynamic changes of pancreatic calcification were noted in groups A and B. Chronologically, three phases of evolution could be distinguished. After an initial increase (phase 1), >50% of cases reached a plateau of stationary calcification (phase 2). Approximately one-third of cases showed a marked decrease of calcification in late phases of chronic pancreatitis (phase 3). Dissolution of pancreatic stones was related primarily to duration of chronic pancreatitis (duration of calcification and marked pancreatic dysfunction), and occurred frequently (but not exclusively) in patients after ductal drainage procedures. These results indicate that spontaneous dissolution of pancreatic stones is a rather common biologic phenomenon. The factors responsible for dissolution of stones remain to be elucidated.

Vanishing Pancreatic Calcification in Chronic Pancreatitis: Sign of Pancreatic Carcinoma

Vanishing Pancreatic Calcification in Chronic Pancreatitis: Sign of Pancreatic Carcinoma

Vanishing pancreatic calcification in chronic pancreatitis. A sign of pancreatic carcinoma.

ROENTGENOGRAPHIC evidence of pancreatic calcification has been noted in approximately 25 per cent of patients with idiopathic chronic pancreatitis and in 50 per cent of cases of recurrent pancreatitis associated with alcoholism.1 , 2 Calcification developing within a primary pancreatic carcinoma is relatively rare. However, the converse does not appear to be true, and indeed, the reported incidence of pancreatic carcinoma in patients with chronic calcific pancreatitis has been 9.4 and 25 per cent.1 , 3 The case reported below was considered unique because during the course of chronic calcific pancreatitis, roentgenographic evidence of pancreatic decalcification was observed and post-mortem examination revealed a primary . . .