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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Cohen SM, Kent TS. Etiology, Diagnosis, and Modern Management of Chronic Pancreatitis: A Systematic Review. JJAMA Surg. 158(6):652-661, 2023 06 01. Review/Other-Dx 75 studies To summarize the most current published evidence on etiology, diagnosis, and management of chronic pancreatitis and its associated complications. No results stated in the abstract. 4
2. Ketwaroo GA, Freedman SD, Sheth SG. Approach to patients with suspected chronic pancreatitis: a comprehensive review. [Review]. Pancreas. 44(2):173-80, 2015 Mar.Pancreas. 44(2):173-80, 2015 Mar.
3. Whitcomb DC, Shimosegawa T, Chari ST, et al. International consensus statements on early chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with The International Association of Pancreatology, American Pancreatic Association, Japan Pancreas Society, PancreasFest Working Group and European Pancreatic Club. Pancreatology 18:516-527, 2018 Jul.
4. Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120:682-707, 2001 Feb.
5. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007 Feb;42(2):101-19. Review/Other-Tx N/A To develop a new classification system of chronic pancreatitis to provide a framework for studying the interaction of various risk factors on the course of the disease. We established the M-ANNHEIM multiple risk factor classification system based on the current knowledge of acute and chronic pancreatitis. This classification allows patients to be categorized according to the etiology, clinical stage, and severity of their disease. The severity of pancreatic inflammation was assessed using a scoring system that takes into account the clinical symptoms and treatment options of chronic pancreatitis. Finally, four hypothetical patients were categorized according to the M-ANNHEIM classification system to provide examples of its applicability in clinical practice. 4
6. Conwell DL, Lee LS, Yadav D, et al. American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 43(8):1143-62, 2014 Nov. Review/Other-Dx N/A This American Pancreatic Association Practice Guidelines in Chronic Pancreatitis: Evidence-Based Report on Diagnostic Guidelines is to define the diagnostic criteria useful in the assessment of patients with suspected and established chronic pancreatitis. No results state in the abstract. 4
7. Sankaran SJ, Xiao AY, Wu LM, Windsor JA, Forsmark CE, Petrov MS. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology 149:1490-1500.e1, 2015 Nov.
8. Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017 Mar;5(2):153-199. Review/Other-Dx N/A To provide evidence-based recommendations for the diagnosis and medical, endoscopic and surgical management of chronic pancreatitis (CP), with particular emphasis on the diagnosis and treatment of pancreatic exocrine insufficiency (PEI) as the major symptom. The 101 recommendations covered 12 topics related to the clinical management of chronic pancreatitis: aetiology (working party (WP)1), diagnosis of chronic pancreatitis with imaging (WP2 and WP3), diagnosis of pancreatic exocrine insufficiency (WP4), surgery in chronic pancreatitis (WP5), medical therapy (WP6), endoscopic therapy (WP7), treatment of pancreatic pseudocysts (WP8), pancreatic pain (WP9), nutrition and malnutrition (WP10), diabetes mellitus (WP11) and the natural course of the disease and quality of life (WP12). Using the Grading of Recommendations Assessment, Development and Evaluation system, 70 of the 101 (70%) recommendations were rated as 'strong' and plenary voting revealed 'strong agreement' for 99 (98%) recommendations. 4
9. Bieliuniene E, Brondum Frokjaer J, Pockevicius A, et al. CT- and MRI-Based Assessment of Body Composition and Pancreatic Fibrosis Reveals High Incidence of Clinically Significant Metabolic Changes That Affect the Quality of Life and Treatment Outcomes of Patients with Chronic Pancreatitis and Pancreatic Cancer. Medicina (Kaunas). 55(10), 2019 Sep 27. Observational-Dx 100 patients with diagnosed CP or PDAC To evaluate radiological changes in body composition and to compare them with manifestations of exocrine and endocrine pancreatic insufficiency, body mass, and quality of life (QOL) among patients with chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC). There was no significant difference in skeletal muscle mass (SMM) among patients with CP and PDAC (p = 0.85). Significantly more underweight patients had low SMM (p = 0.002). Patients with CP had more pronounced pancreatic fibrosis (PF) (p < 0.001). Data showed a significant relationship between a high degree of PF and occurrence of diabetes (p = 0.006) and low fecal elastase-1 levels (p = 0.013). A statistically significant lower QOL was determined in patients with PF = 50% and in the CP group. 3
10. Wilcox CM, Yadav D, Ye T, et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clinical Gastroenterology & Hepatology. 13(3):552-60; quiz e28-9, 2015 Mar.Clin Gastroenterol Hepatol. 13(3):552-60; quiz e28-9, 2015 Mar.
11. Duggan SN, Ni Chonchubhair HM, Lawal O, O'Connor DB, Conlon KC. Chronic pancreatitis: A diagnostic dilemma. [Review]. World Journal of Gastroenterology. 22(7):2304-13, 2016 Feb 21.World J Gastroenterol. 22(7):2304-13, 2016 Feb 21.
12. Bouça-Machado T, Bouwense SAW, Brand M, et al. Position statement on the definition, incidence, diagnosis and outcome of acute on chronic pancreatitis. Pancreatology. 2023 Mar;23(2):S1424-3903(23)00035-2. Review/Other-Dx N/A To develop consensus amongst experts on the definition, incidence, diagnostic criteria and outcomes for acute on chronic pancreatitis (ACP), based on a systematic review of the available literature. The quality of evidence, for most statements, was low to very low, which means that the recommendations in general are only conditional. Despite that, it was possible to reach strong levels of agreement by the expert panel for all 10 questions. A new consensus definition of ACP was reached. Although common, the real incidence of ACP is not known, with alcohol as a major risk factor. Although pain dominates, other non-specific symptoms and signs can be present. Serum levels of pancreatic enzymes may be less than 3 times the upper limit of normal and cross-sectional imaging is considered more accurate for the diagnosis in many cases. It appears that it is less severe and with a lower mortality risk than acute pancreatitis. 4
13. Szucs A, Marjai T, Szentesi A, et al. Chronic pancreatitis: Multicentre prospective data collection and analysis by the Hungarian Pancreatic Study Group. PLoS ONE [Electronic Resource]. 12(2):e0171420, 2017.PLoS ONE. 12(2):e0171420, 2017.
14. Singh VK, Yadav D, Garg PK. Diagnosis and Management of Chronic Pancreatitis: A Review. [Review]. JAMA. 322(24):2422-2434, 2019 Dec 24. Review/Other-Dx N/A To summarize current evidence regarding risk factors, pathophysiology, clinical features, diagnostic evaluation, treatment, and prognosis of CP Both genetic and environmental factors are thought to contribute to the pathogenesis of CP. Environmental factors associated with CP include alcohol abuse (odds ratio [OR], 3.1; 95% CI, 1.87-5.14) for 5 or more drinks per day vs abstainers and light drinkers as well as smoking (OR, 4.59; 95% CI, 2.91-7.25) for more than 35 pack-years in a case-control study involving 971 participants. Between 28% to 80% of patients are classified as having "idiopathic CP." Up to 50% of these individuals have mutations of the trypsin inhibitor gene (SPINK1) or the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Approximately 1% of people diagnosed with CP may have hereditary pancreatitis, associated with cationic trypsinogen (PRSS1) gene mutations. Approximately 80% of people with CP present with recurrent or chronic upper abdominal pain. Long-term sequelae include diabetes in 38% to 40% and exocrine insufficiency in 30% to 48%. The diagnosis is based on pancreatic calcifications, ductal dilatation, and atrophy visualized by imaging with computed tomography, magnetic resonance imaging, or both. Endoscopic ultrasound can assist in making the diagnosis in patients with a high index of suspicion such as recurrent episodes of acute pancreatitis when imaging is normal or equivocal. The first line of therapy consists of advice to discontinue use of alcohol and smoking and taking analgesic agents (nonsteroidal anti-inflammatory drugs and weak opioids such as tramadol). A trial of pancreatic enzymes and antioxidants (a combination of multivitamins, selenium, and methionine) can control symptoms in up to 50% of patients. Patients with pancreatic ductal obstruction due to stones, stricture, or both may benefit from ductal drainage via endoscopic retrograde cholangiopancreatography (ERCP) or surgical drainage procedures, such as pancreaticojejunostomy with or without pancreatic head resection, which may provide better pain relief among people who do not respond to endoscopic therapy. 4
15. Sharma D, Mallick B, Samanta J, Gupta V, Sinha SK, Kochhar R. Acute-on-Chronic Pancreatitis: Analysis of Clinical Profile and Outcome. Cureus 13:e14242, 2021 Apr.
16. Liu J, Wang C, Chen Z, Dai Q, Bai J, Cui YF. Analysis of risk factors related to acute exacerbation in patients with chronic pancreatitis: a retrospective study of 313 cases from a single center in China. BMC Gastroenterol 24:436, 2024 Nov.
17. Akshintala VS, Hutfless SM, Yadav D, et al. A population-based study of severity in patients with acute on chronic pancreatitis. Pancreas 42:1245-50, 2013 Nov.
18. Laaninen M, Bläuer M, Sand J, Nordback I, Laukkarinen J. Difference in Early Activation of NF-?B and MCP-1 in Acinar-Cell-Rich versus Fibrotic Human Pancreas Exposed to Surgical Trauma and Hypoxia. Gastroenterol Res Pract 2014:460363, 2014 .
19. Limon O, Sahin E, Kantar FU, Oray D, Ugurhan AA. A rare entity in ED: Normal lipase level in acute pancreatitis. Turk J Emerg Med 16:32-4, 2016 Mar.
20. Porter KK, Zaheer A, Kamel IR, et al. ACR Appropriateness Criteria® Acute Pancreatitis. J Am Coll Radiol 2019;16:S316-S30. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute pancreatitis. No results stated in abstract. 4
21. Merdrignac A, Sulpice L, Rayar M, et al. Pancreatic head cancer in patients with chronic pancreatitis. Hepatobiliary & Pancreatic Diseases International. 13(2):192-7, 2014 Apr.Hepatobiliary Pancreat Dis Int. 13(2):192-7, 2014 Apr.
22. Tirkes T. Chronic Pancreatitis: What the Clinician Wants to Know from MR Imaging. [Review]. Magnetic Resonance Imaging Clinics of North America. 26(3):451-461, 2018 Aug.Magn Reson Imaging Clin N Am. 26(3):451-461, 2018 Aug.
23. Qayyum A, Tamm EP, Kamel IR, et al. ACR Appropriateness Criteria® Staging of Pancreatic Ductal Adenocarcinoma. J Am Coll Radiol 2017;14:S560-S69. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for staging of pancreatic ductal adencarcinoma. No results stated in abstract. 4
24. Hegyi P, Párniczky A, Lerch MM, et al. International Consensus Guidelines for Risk Factors in Chronic Pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 20:579-585, 2020 Jun.
25. Beyer G, Habtezion A, Werner J, Lerch MM, Mayerle J. Chronic pancreatitis. [Review]. Lancet. 396(10249):499-512, 2020 08 15. Review/Other-Dx N/A Chronic pancreatitis is a multifactorial, fibroinflammatory syndrome in which repetitive episodes of pancreatic inflammation lead to extensive fibrotic tissue replacement, resulting in chronic pain, exocrine and endocrine pancreatic insufficiency, reduced quality of life, and a shorter life expectancy. No results stated in abstract. 4
26. Issa Y, Kempeneers MA, van Santvoort HC, Bollen TL, Bipat S, Boermeester MA. Diagnostic performance of imaging modalities in chronic pancreatitis: a systematic review and meta-analysis. [Review]. Eur Radiol. 27(9):3820-3844, 2017 Sep. Meta-analysis 3460 Obtain summary estimates of sensitivity and specificity for imaging modalities for chronic pancreatitis (CP) assessment. We included 43 studies evaluating 3460 patients. Sensitivity of endoscopic retrograde cholangiopancreatography (ERCP) (82%; 95%CI: 76%-87%) was significant higher than that of abdominal ultrasonography (US) (67%; 95%CI: 53%-78%; P=0.018). The sensitivity estimates of endoscopic ultrasonography (EUS), magnetic resonance imaging (MRI), and computed tomography (CT) were 81% (95%CI: 70%-89%), 78% (95%CI: 69%-85%), and 75% (95%CI: 66%-83%), respectively, and did not differ significantly from each other. Estimates of specificity were comparable for EUS (90%; 95%CI: 82%-95%), ERCP (94%; 95%CI: 87%-98%), CT (91%; 95% CI: 81%-96%), MRI (96%; 95%CI: 90%-98%), and US (98%; 95%CI: 89%-100%). Good
27. Issa Y, van Santvoort HC, Fockens P, et al. Diagnosis and treatment in chronic pancreatitis: an international survey and case vignette study. HPB. 19(11):978-985, 2017 11. Review/Other-Dx 288 pancreatologists The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Büchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. 4
28. Hoffmeister A, Mayerle J, Beglinger C, et al. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis. Z Gastroenterol. 2015 Dec;53(12):1447-95.
29. Strand DS, Law RJ, Yang D, Elmunzer BJ. AGA Clinical Practice Update on the Endoscopic Approach to Recurrent Acute and Chronic Pancreatitis: Expert Review. [Review]. Gastroenterology. 163(4):1107-1114, 2022 10.Gastroenterology. 163(4):1107-1114, 2022 10.
30. Shintani S, Inatomi O, Hiroe K, et al. The diagnostic accuracy of endoscopic ultrasound-shear wave elastography in multiple pancreatic regions for chronic pancreatitis based on the Rosemont criteria. Journal of Medical Ultrasonics. 50(4):485-492, 2023 Oct.J Med Ultrason (2001). 50(4):485-492, 2023 Oct.
31. Madzak A, Olesen SS, Wathle GK, Haldorsen IS, Drewes AM, Frøkjær JB. Secretin-Stimulated Magnetic Resonance Imaging Assessment of the Benign Pancreatic Disorders: Systematic Review and Proposal for a Standardized Protocol. Pancreas. 2016 Sep;45(8):1092-103. Review/Other-Dx N/A The aim is to provide an overview, for clinicians and radiologist, of the s-MRI protocols and the range of clinical applications. Furthermore, the review will summarize the criteria forevaluation of pancreatic morphology and function based on s-MRI. The literature search indentified 69 original articles and 15 reviews. Chronic pancreatitis was the disease that was most frequently assessed by s-MRI (33%),followed by acute pancreatitis (9%). Dynamic thick-slab 2-dimensional magnetic resonance cholangiopancreatography was the most used imaging sequence (86%). The diameter of the main pancreatic duct (75%) andpancreatic exocrine function based on visual grading of duodenal filling (67%) were the most evaluated pancreatic features. Sufficient similarities between studies were identified to propose the most agreeable standardizeds-MRI protocol for morphological and functional assessment of the pancreas. In the future, more research and increased collaboration between centers is necessary to achieve more consensus and optimization of s-MRI protocols. 4
32. Frokjaer JB, Akisik F, Farooq A, et al. Guidelines for the Diagnostic Cross Sectional Imaging and Severity Scoring of Chronic Pancreatitis. Pancreatology. 18(7):764-773, 2018 Oct. Review/Other-Dx n/a The paper presents the international guidelines for imaging evaluation of chronic pancreatitis. CT is often the most appropriate initial imaging modality for the evaluation of patients with suspected CP. All patients with a suspected diagnosis of CP should in most cases undergo a baseline CTimaging. The diagnosis of mild/early CP remains challenging. However, MRI/MRCP and especially secretin-stimulated MRCP, or alternatively EUS, is more accurate in the depiction of these subtlechanges. There is a need for a validated radiological scoring system based on imaging criteria including glandular volume loss, ductal changes, parenchymal calcifications, parenchymal fibrosis andexocrine function based on CT and MRI. 4
33. Tirkes T, Yadav D, Conwell DL, et al. Multiparametric MRI Scoring System of the Pancreas for the Diagnosis of Chronic Pancreatitis. J Magn Reson Imaging. 2025 May;61(5):2183-2194. Experimental-Dx 137 Diagnose CP based on multiparametric MRI and MRCP features. Compared to control, definite CP cohort showed significantly higher dual-echo FF (7% vs. 11%), lower AVR (1.35 vs. 0.85), smaller PTD (2.5 cm vs. 1.95 cm), higher ECV (28% vs. 38%), and higher incidence of PDE loss (6.5% vs. 50%). With the cut-off of >2.5 CP-MRI score (dual-echo FF, AVR, and PTD) and CP-SMRI score (dual-echo FF, AVR, PTD, and PDE) had cross-validated area under the curves of 0.84 (sensitivity 87%, specificity 68%) and 0.86 (sensitivity 89%, specificity 67%), respectively. Interobserver agreement for both CP-MRI and CP-SMRI scores was 0.74. 4
34. Frulloni L, Falconi M, Gabbrielli A, et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010 Nov;42 Suppl 6():S381-406. Review/Other-Dx N/A To provide practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. 4
35. Nordaas IK, Dimcevski G, Gilja OH, Havre RF, Haldorsen IS, Engjom T. Diagnostic Accuracy of Computed Tomography Scores in Chronic Pancreatitis. Pancreas. 50(4):549-555, 2021 04 01. Review/Other-Dx 118 We aimed to evaluate the diagnostic accuracy of CT scores for diagnosing CP. Seventy-six of the 118 patients fulfilled the CP diagnostic criteria (Mayo score =4). The modified Cambridge classification and theunweighted CT score yielded sensitivities of 63% and 67% and specificities of 91% and 91%, respectively, and similar areas under the receiver operatingcharacteristic curves (95% confidence interval) of 0.79 (0.71–0.88)/0.81 (0.73–0.89), respectively (P, not significant). 4
36. Anaizi A, Hart PA, Conwell DL. Diagnosing Chronic Pancreatitis. Dig Dis Sci. 2017 Jul;62(7):1713-1720. Review/Other-Dx N/A Diagnosing CP can range from routine in those with severe disease and obvious calcifications on CT imaging to elusive in those patients with early changes in CP. No results stated in abstract. 4
37. Wolske KM, Ponnatapura J, Kolokythas O, Burke LMB, Tappouni R, Lalwani N. Chronic Pancreatitis or Pancreatic Tumor? A Problem-solving Approach. [Review]. Radiographics. 39(7):1965-1982, 2019 Nov-Dec. Review/Other-Dx N/A To discuss a problem-solving approach for chronic pancreatitis or a pancreatic tumor. No results stated in the abstract. 4
38. Srisajjakul S, Prapaisilp P, Bangchokdee S. CT and MR features that can help to differentiate between focal chronic pancreatitis and pancreatic cancer. [Review]. Radiol Med (Torino). 125(4):356-364, 2020 Apr. Review/Other-Dx N/A Ro describe the strong CT and MR imaging features or integrated imaging features that can help to differentiate between pancreatic cancer and focal chronic pancreatitis. No results stated in abstract. 4
39. Tirkes T, Shah ZK, Takahashi N, et al. Inter-observer variability of radiologists for Cambridge classification of chronic pancreatitis using CT and MRCP: results from a large multi-center study. Abdom Radiol. 45(5):1481-1487, 2020 05. Observational-Dx 39 patients To determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) of chronic pancreatitis (CP) based on magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced CT (CECT). For the majority of subjects (34/39), the group assignment by LR agreed with the consensus composite CT/MRCP score by the CRs (concordance ranging from 75 to 89% depending on cohort group). There was moderate agreement (63% and 67% agreed, respectively) between CRs and LRs in both the CT score (weighted Kappa [95% CI] = 0.56 [0.34, 0.78]; p-value = 0.57) and the MR score (weighted Kappa [95% CI] = 0.68 [0.49, 0.86]; p-value = 0.72). The composite CT/MR score showed moderate agreement (weighted Kappa [95% CI] = 0.62 [0.43, 0.81]; p-value = 0.80). 2
40. Swensson J, Akisik F, Collins D, Olesen SS, Drewes AM, Frokjaer JB. Is Cambridge scoring in chronic pancreatitis the same using ERCP and MRCP?: A need for revision of standards. Abdom Radiol. 46(2):647-654, 2021 02. Review/Other-Dx 325 patients To compare ERCP and MRCP Cambridge scores and evaluates diagnostic performance of MRCP in a large cohort of patients with CP. The cohort comprised 325 patients (mean age 51 years; 56% female). By ERCP Cambridge classification, 122 had mild CP, 109 moderate CP, and 94 severe CP. MRCP and ERCP showed total agreement of Cambridge score in only 43% of cases. With ERCP as reference, the sensitivity and specificity of MRCP in detecting Cambridge scores 4 + 5 (main-duct predominant) were 75.9% and 64.3%, and for Cambridge score 3 (side-branch predominant) it was 60.0% and 76.9%, respectively. 4
41. Tirkes T, Yadav D, Conwell DL, et al. Diagnosis of chronic pancreatitis using semi-quantitative MRI features of the pancreatic parenchyma: results from the multi-institutional MINIMAP study. Abdom Radiol. 48(10):3162-3173, 2023 10. Observational-Dx 50 control and 51 definite CP participants To determine the diagnostic performance of parenchymal MRI features differentiating CP from controls. When compared to controls, CP participants showed a significantly lower mean T1 score (1.11 vs. 1.29), AVR venous (0.86 vs. 1.45), AVR delayed (1.07 vs. 1.57), volume (54.97 vs. 80.00 ml), and diameter of the head (2.05 vs. 2.39 cm), body (2.25 vs. 2.58 cm), and tail (1.98 vs. 2.51 cm) (p < 0.05 for all). AUCs for these individual MR parameters ranged from 0.66 to 0.79, while AUCs for the SQ-MRI scores were 0.82 and 0.81 for Model A (T1 score, AVR venous, and tail diameter) and Model B (T1 score, AVR venous, and volume), respectively. After propensity-matching adjustments for covariates, AUCs for Models A and B of the SQ-MRI scores increased to 0.92 and 0.93, respectively. 2
42. Liu C, Shi Y, Lan G, Xu Y, Yang F. Evaluation of Pancreatic Fibrosis Grading by Multiparametric Quantitative Magnetic Resonance Imaging. J Magn Reson Imaging. 54(5):1417-1429, 2021 11. Observational-Dx 144 patients To determine main pancreatic duct (MPD) diameter, pancreatic thickness, and grades of PF via magnetic resonance elastography (MRE), T1 mapping, and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), assessing respective diagnostic performances. Both pancreatic stiffness (r = 0.754; P < 0.001) and T1 relaxation time (r = 0.433; P < 0.001) correlated significantly with PF (%). To determine PF grades =F1, a combined model (area under the curve [AUC] = 0.906) performed significantly better than pancreatic stiffness (AUC = 0.855; P < 0.001) or T1 relaxation time (AUC = 0.754; P < 0.001) alone. For PF grades =F2 or grade F3, both the combined model (=F2: AUC = 0.910; F3: AUC = 0.939) and pancreatic stiffness (=F2: AUC = 0.906; F3: AUC = 0.929) outperformed T1 relaxation time (=F2: AUC = 0.768 [P = 0.005 and P = 0.004, respectively]; F3: AUC = 0.816 [both P < 0.005]). All IVIM-DWI parameters generated AUC values <0.700. 3
43. Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frokjaer JB. T1 relaxation times and MR elastography-derived stiffness: new potential imaging biomarkers for the assessment of chronic pancreatitis. Abdom Radiol. 46(12):5598-5608, 2021 12. Observational-Dx 19 with mild CP and 35 healthy controls To compare magnetic resonance imaging-based parameters, pancreatic volume, T1 mapping, magnetic resonance elastography (MRE), and proton density fat fraction between CP patients and controls, and determine the diagnostic performance for diagnosing different stages of CP. Pancreatic volume, T1 relaxation times, MRE-derived stiffness, and proton density fat fraction differed significantly between patients with mild CP, moderate/severe CP, and healthy controls (all p < 0.05). T1 mapping and MRE showed a very high diagnostic performance for distinguishing the mild CP group from the control group (T1 mapping: receiver operating characteristic area under the curve (ROC-AUC): 0.94; sensitivity: 84%; specificity: 91%, MRE: ROC-AUC: 0.93; sensitivity: 89%; specificity: 94%). T1 mapping and MRE also had the highest performance for diagnosing the presence of any CP from the control group (ROC-AUCs of 0.98 and 0.97, respectively). 3
44. Steinkohl E, Olesen SS, Hansen TM, Drewes AM, Frokjaer JB. Quantification of parenchymal fibrosis in chronic pancreatitis: relation to atrophy and pancreatic function. Acta Radiol. 64(3):936-944, 2023 Mar. Review/Other-Dx 49 patients To investigate the correlation between magnetic resonance elastography (MRE)-derived stiffness and T1 relaxation times (as proxies of fibrosis) and explore their relationships to gland volume and pancreatic functions in patients with CP and healthy controls (HCs). There was a positive correlation between MRE-derived stiffness and T1 relaxation times in patients with CP (R2 = 0.42; P < 0.001) and HCs (R2 = 0.14; P = 0.028). There was no correlation between MRE-derived stiffness and gland volume in patients (R2 = 0.007; P = 0.065) or HCs (R2 = 0.010; P = 0.57). T1 relaxation time was correlated to gland volume (R2 = 0.19; P = 0.002) in patients with CP but not in the HCs (P = 0.056). Severity of pancreatic functional impairment was reflected by increased fibrosis-related parameters in patients without functional impairment, followed by a further increase in fibrosis-related parameters and reduction in gland volume in patients with pancreatic functional impairments. 4
45. Tirkes T, Fogel EL, Sherman S, et al. Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis. Abdom Radiol. 42(2):544-551, 2017 02. Review/Other-Dx 51 suspected CP patient To determine if T1-weighted MR signal of the pancreas can be used to detect early CP. There was a significant difference in the signal intensity ratio of the pancreas to spleen (SIRp/s) between the normal and low bicarbonate groups (p < 0.0001). A significant positive correlation was found between pancreatic fluid bicarbonate level and SIRp/s (p < 0.0001). SIRp/s of 1.2 yielded sensitivity of 77% and specificity of 83% for detection of pancreatic exocrine dysfunction (AUC: 0.89). 4
46. Cheng M, Gromski MA, Fogel EL, DeWitt JM, Patel AA, Tirkes T. T1 mapping for the diagnosis of early chronic pancreatitis: correlation with Cambridge classification system. Br J Radiol. 94(1121):20200685, 2021 May 01. Review/Other-Dx 42 patients To determine if T1 relaxation time of the pancreas can detect parenchymal changes in early chronic pancreatitis (CP). There was no significant difference between the T1 relaxation times of Cambridge 0 and 1 group (p = 0.58). There was a significant difference (p = 0.0003) in the mean T1 relaxation times of the pancreas between the combined Cambridge 0 and 1 (mean = 639 msec, 95% CI: 617, 660) and Cambridge 2 groups (mean = 726 msec, 95% CI: 692, 759). There was significant difference (p = 0.0009) in the mean T1 relaxation times of the pancreas between the Cambridge 0 (mean = 636 msec, 95% CI: 606, 666) and Cambridge 2 groups (mean = 726 msec, 95% CI: 692,759) as well as between Cambridge 1 (mean = 643 msec, 95% CI: 608, 679) and Cambridge 2 groups (mean = 726 msec, 95% CI: 692,759) (p = 0.0017). Bland-Altman analysis showed measurements of one reader to be marginally higher than the other by 15.7 msec (2.4%, p = 0.04). 4
47. Tirkes T, Dasyam AK, Shah ZK, et al. T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis. Abdom Radiol. 47(10):3507-3519, 2022 10. Experimental-Dx 820 Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study. The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p < 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals. 1
48. Parakh A, Tirkes T. Advanced imaging techniques for chronic pancreatitis. [Review]. Abdom Radiol. 45(5):1420-1438, 2020 05. Review/Other-Dx N/A To review advanced imaging techniques by MRI, MRCP, CT, and ultrasound. No results in abstract. 4
49. Olesen SS, Steinkohl E, Hansen TM, Drewes AM, Frokjaer JB. Single- and multiparameter magnetic resonance imaging for diagnosing and severity grading of chronic pancreatitis. Abdom Radiol. 48(2):630-641, 2023 02. Experimental-Dx 89 The study aimed to determine the performance of advanced magnetic resonance imaging (MRI), including a multiparametric MRI-index, for diagnosing and severity grading of chronic pancreatitis (CP) at various functional stages with focus on detection of CP with preserved pancreatic function. All MRI parameters differed across CP subgroups and healthy controls (all P < 0.001), except for IVIM. T1 relaxation time (ROC area under the curve (ROC-AUC) 0.82), MRE (ROC-AUC 0.88), and MRI-index (ROC-AUC 0.86) showed the highest performance for detecting patients with preserved pancreatic function (early CP) vs. healthy controls. For detecting preserved pancreatic function vs. partial insufficiency, pancreatic volume, MRI-index, and T1 relaxation time performed best (all ROC-AUC > 0.75), with the MRI-index tending to outperform MRE (ROC-AUC 0.77 vs. 0.63; P = 0.10). 3
50. Tirkes T, Shah ZK, Takahashi N, et al. Reporting Standards for Chronic Pancreatitis by Using CT, MRI, and MR Cholangiopancreatography: The Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer. Radiology. 290(1):207-215, 2019 01. Review/Other-Dx N/A This consensus statement presents and defines features of chronic pancreatitis along with recommended reporting metrics. The Adult Chronic Pancreatitis Working Group of the CPDPChas proposed new imaging reporting standards for specificfeatures of chronic pancreatitis at CT, MRI, and MR cholan-giopancreatography. Standardized qualitative and quantitativefeatures may improve radiologic phenotyping of patients withCP and provide a metric for longitudinal assessment for clini-cal trials. Future use of these standardized metrics in well-con-trolled clinical trials will help to validate them and potentiallyallow for clinical adoption. 4
51. Razek AAKA, Elfar E, Abubacker S. Interobserver agreement of computed tomography reporting standards for chronic pancreatitis. Abdom Radiol. 44(7):2459-2465, 2019 07. Observational-Dx 47 To assess the interobserver agreement of computed tomography (CT) reporting standards for chronic pancreatitis (CP). There was excellent interobserver agreement (84.8 %) between the two reviewers in CT reporting standards for CP (K = 0.80, 95 % CI 0.75-0.85, P = 0.001). There was good interobserver agreement for pancreatic duct (PD) caliber (K = 0.71, 95 % CI 0.56-0.87, P = 0.001), PD contour (K = 0.76, 95 % CI 0.61-0.91, P = 0.001), PD stricture (K = 0.070, 95 % CI 0.53-0.88, P = 0.001), and distribution of findings (K = 0.69, 95 % CI 0.51-0.86, P = 0.001). There was excellent interobserver agreement for intraductal calculi (K = 0.84, 95 % CI 0.68-0.98, P = 0.001), pancreatic calcifications (K = 0.86, 95 % CI 0.84-0.98, P = 0.001), and pancreatic diameter (K = 0.87, 95 % CI 0.75-0.99, P = 0.001). 2
52. Andersen PL, Madzak A, Olesen SS, Drewes AM, Frokjaer JB. Quantification of parenchymal calcifications in chronic pancreatitis: relation to atrophy, ductal changes, fibrosis and clinical parameters. Scand J Gastroenterol. 53(2):218-224, 2018 Feb. Review/Other-Dx 54 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. 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). 4
53. Zeng XP, Zhu XY, Li BR, et al. Spatial Distribution of Pancreatic Stones in Chronic Pancreatitis. Pancreas. 47(7):864-870, 2018 08. Experimental-Dx 247 The aim of this study was to establish a standard to describe the spatial distribution of pancreatic stones in chronic pancreatitis (CP). The mean value of n and s were 13.6 and 22.5; n > 13.6 and s > 22.5 were determined as "multistones" and "nonuniform," respectively. Compared with alcoholic CP, idiopathic CP was less prone to multistones (odds ratio [OR], 0.310) and more prone to nonuniform (OR, 3.247). Pancreatic pseudocyst (OR, 2.211) in CP course was a risk factor of multistones, whereas diabetes mellitus in first-/second-/third-degree relatives (OR, 0.382) was a protective factor. Age at diagnosis of pancreatic stones (OR, 1.022) was a risk factor of nonuniformity. 4
54. Anderson SW, Soto JA. Pancreatic duct evaluation: accuracy of portal venous phase 64 MDCT. Abdominal Imaging. 34(1):55-63, 2009 Jan-Feb.Abdom Imaging. 34(1):55-63, 2009 Jan-Feb. Review/Other-Dx 93 Purpose of this study was to evaluate portal venous phase 64 multi-row detector CT (MDCT) scans for detecting pancreatic duct strictures,stones, pancreas divisum, and communication between pancreatic ducts and cystic pancreatic lesions. On standard of reference examinations, 15 (16%) of the 93 patients had a pancreatic duct stricture. The sensitivity and the specificity for Observer 1 were87% and 100%, respectively; for Observer 2, 100% and 100%, respectively. Six (6%) of the 93 patients had main pancreatic duct stones. The sensitivity and the specificityfor Observer 1 were 83% and 100%, respectively; for Observer 2, 100% and 99%, respectively. Five (5%) patients had pancreas divisum; Observer 1 correctlyidentified four and Observer 2 correctly identified three cases. Eleven (12%) patients had cystic pancreatic lesions. Observer 1 correctly determined whether or notthere was communication between the cystic pancreatic lesion and the pancreatic duct in ten cases; Observer 2 correctly made this determination in nine cases. 4
55. Dasyam AK, Shah ZK, Tirkes T, Dasyam N, Borhani AA. Cross-sectional imaging-based severity scoring of chronic pancreatitis: why it is necessary and how it can be done. [Review]. Abdom Radiol. 45(5):1447-1457, 2020 05. Review/Other-Dx N/A To discuss the need for cross-sectional imaging-based severity scoring for chronic pancreatitis, role of CT, and MRI/MRCP in assessment of chronic pancreatitisand how these modalities can be used to obtain severity scoring for chronic pancreatitis. No results stated in abstract. 4
56. Borgbjerg J, Steinkohl E, Olesen SS, et al. Inter- and intra-observer variability of computed tomography-based parenchymal- and ductal diameters in chronic pancreatitis: a multi-observer international study. Abdom Radiol. 48(1):306-317, 2023 01. Experimental-Dx 50 The need for incorporation of quantitative imaging biomarkers of pancreatic parenchymal and ductal structures has been highlighted in recent proposals for new scoring systems in chronic pancreatitis (CP). To quantify inter- and intraobserver variability in CT-based measurements of ductal- and gland diameters in CP patients. The 16 observers completed 6400 caliper placements comprising a frst and second measurement session. Thewidest inter-observer LOAM was seen with PDhead (±9.1 mm), followed by PDbody (±5.1 mm), MPDhead (±3.2 mm),and MPDbody (±2.6 mm), whereas the mean intra-observer LoA width was±7.3,±5.1,±3.7, and±2.4 mm, respectively. 4
57. Ramsey ML, Conwell DL, Hart PA. Complications of Chronic Pancreatitis. Dig Dis Sci. 2017 Jul;62(7):1745-1750. Review/Other-Tx N/A To review our current understanding of the mechanisms and management of these complications of chronic pancreatitis. No results stated in the abstract. 4
58. Lalwani N, Mannelli L, Ganeshan DM, et al. Uncommon pancreatic tumors and pseudotumors. Abdom Imaging. 2015 Jan;40(1):167-80. Review/Other-Dx N/A To discuss imaging characteristics and features of uncommon pancreatic tumors and pseudotumors. No results stated in the abstract. 4
59. Almeida RR, Lo GC, Patino M, Bizzo B, Canellas R, Sahani DV. Advances in Pancreatic CT Imaging. AJR Am J Roentgenol. 2018 Jul;211(1):52-66. Review/Other-Dx N/A To discuss the advances in CT acquisition and image postprocessing as they apply to imaging the pancreas and to conceptualize the role of radiogenomics and machine learning in pancreatic imaging. No results stated in abstract. 4
60. Narang M, Singh A, Mahapatra SJ, et al. Utility of dual-energy CT and advanced multiparametric MRI based imaging biomarkers of pancreatic fibrosis in grading the severity of chronic pancreatitis. Abdom Radiol. 49(10):3528-3539, 2024 Oct. Experimental-Dx 72 To non-invasively quantify pancreatic fibrosis and grade severity of chronic pancreatitis (CP) on dual-energy CT (DECT) and multiparametric MRI (mpMRI). NIC of pancreas in controls and progressive grades of CP were 0.24 ± 0.05, 0.80 ± 0.18, 1.06 ± 0.23, 1.40 ± 0.36, FF were 9.28 ± 5.89, 14.19 ± 5.29, 17.31 ± 5.99, 29.32 ± 12.22, T1Rt were 590.11 ± 61.13, 801.93 ± 211.01, 1006.79 ± 352.18, 1388.01 ± 312.23ms, ECVf were 0.07 ± 0.03, 0.30 ± 0.12, 0.41 ± 0.12, 0.53 ± 0.13, PF were 0.38 ± 0.04, 0.28 ± 0.07, 0.25 ± 0.09, 0.21 ± 0.05 and MTR were 0.12 ± 0.03, 0.15 ± 0.06, 0.21 ± 0.07, 0.26 ± 0.06, respectively. There were significant differences for all quantitative parameters between controls and mild CP; for NIC, PF, and ECVf between controls and progressive CP grades (p < 0.05). Area under curve for NIC, FF, T1Rt, ECVf, PF, and MTR in differentiating controls and mild CP were 1.00, 0.86, 0.95, 1.00, 0.90 and 0.84 respectively and for NIC, FF, ECVf and PF in differentiating controls and equivocal CP were 1.00, 0.76, 0.95 and 0.92 respectively. 3
61. Dasyam AK, Vipperla K, Slivka A, et al. Computed tomography based scoring system in a prospectively ascertained cohort of patients with chronic pancreatitis. Pancreatology. 19(8):1027-1033, 2019 Dec. Observational-Dx 158 No standardized system is currently used to report the presence or severity of parenchymal and ductal features of chronic pancreatitis (CP) on CT scan. We report a modification to the previously proposed Cambridge classification to serve this purpose. Pancreatic atrophy, calcifications, PD dilation and PD irregularity were observed in 80%, 68%, 65%, 58% cases, respectively. An obstructive stone or PD stricture was present in 63%, and 86% had diffuse pancreatic involvement. Using these features, CP was noted to be moderate or severe in 61%, and classified morphologically as obstructive with/without calcifications, calcific but non-obstructive and non-calcific/non-obstructive in 65%, 20%, 15%, respectively. Functional abnormalities but not the presence of pain generally correlated with imaging findings. 2
62. Miller FH, Lopes Vendrami C, Hammond NA, Mittal PK, Nikolaidis P, Jawahar A. Pancreatic Cancer and Its Mimics. Radiographics. 2023 Nov;43(11):e230054. Review/Other-Dx N/A To describe the typical and atypical imaging findings of PDAC and features that may help to differentiate PDAC from its mimics. No results stated in abstract. 4
63. Inomata N, Masuda A, Yamakawa K, et al. Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis. J Gastroenterol Hepatol. 38(1):103-111, 2023 Jan. Observational-Dx 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery To elucidate the frequency of pancreatic parenchymal EUS ?ndings, such as hyperechoic foci, stranding, andlobularity, in patients without CP as well as the association be-tween these EUS ?ndings and CP histological features by designing a large-scale retrospective study analyzing over 200 surgically resected specimens of several types of pancreatobiliary diseases. Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2-7.9] vs 31.3 [9.3-105.6], Ptrend < 0.001; 3.9 [1.9-8.2] vs 21.8 [8.0-59.4], Ptrend < 0.001; and 4.0 [2.0-7.8] vs 22.9 [7.0-74.5], Ptrend < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. 3
64. Trikudanathan G, Vega-Peralta J, Malli A, et al. Diagnostic Performance of Endoscopic Ultrasound (EUS) for Non-Calcific Chronic Pancreatitis (NCCP) Based on Histopathology. Am J Gastroenterol. 111(4):568-74, 2016 Apr. Observational-Dx 68 patients To assess correlation of standard EUS features for CP with surgical histopathology in a large cohort of patients with non-calcific CP (NCCP). 68 patients (56 females, mean±s.d. age-38.77±10.92) underwent TPIAT for NCCP with pre-operative EUS. ROC curve showed that four or more EUS features provided the best balance of sensitivity (61%), specificity (75%), and accuracy (63%). Although significant, correlation between standard EUS features and degree of fibrosis was poor (r=0.24, P<0.05). Multivariate regression analysis showed that main pancreatic duct irregularity was the only independent EUS feature (P=0.02) which predicted CP. 2
65. Mel Wilcox C, Gress T, Boermeester M, et al. International consensus guidelines on the role of diagnostic endoscopic ultrasound in the management of chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology. 20(5):822-827, 2020 Jul. Review/Other-Dx N/A To provide internationally applicable recommendations for practicing clinicians on the diagnostic role of endoscopic ultrasonography (EUS)for chronic pancreatitis (CP). Strong consensus was obtained for both of the following statements [1]. The ideal threshold number of EUS criteria necessary to diagnose CP has not been firmly established, but the presence of 5 or more and 2 or less strongly suggests or refutes the diagnosis, respectively. The Rosemont scoring system standardizes the reporting of EUS signs indicative of chronic pancreatitis, but further studies are needed to demonstrate an overall improvement of its diagnostic accuracy over conventional scoring [2]. Specificity, inter- and intra-observer variability and pre-test probability limit the reliability and utility of EUS to help diagnose CP especially early stages of the disease. 4
66. Majumder S, Chari ST. Chronic pancreatitis. [Review]. Lancet. 387(10031):1957-66, 2016 May 07. Review/Other-Dx N/A To discuss the clinical features, diagnosis, and management of chronic calcifying pancreatitis, focusing on pain management, the role of endoscopic and surgical intervention, and the use of pancreatic enzyme-replacement therapy. No results stated in abstract. 4
67. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 69(7):1251-61, 2009 Jun. Review/Other-Dx N/A To establish consensus-based criteria for EUS features of CP. Major criteria for CP were (1) hyperechoic foci with shadowing and main pancreatic duct (PD) calculi and (2) lobularity with honeycombing. Minor criteria for CP were cysts, dilated ducts > or =3.5 mm, irregular PD contour, dilated side branches > or =1 mm, hyperechoic duct wall, strands, nonshadowing hyperechoic foci, and lobularity with noncontiguous lobules. 4
68. Yamamiya A, Irisawa A, Abe Y, et al. Diagnosing chronic pancreatitis by endoscopic ultrasound assessing the association between ultrasound and pathological findings: A narrative review. DEN Open. 2023 Apr;3(1):e164. Review/Other-Dx N/A Discussion of the diagnosis of CP/early CP by EUS, particularly assessing the association between ultrasound and pathological findings. No results stated in abstract. 4
69. Sato A, Irisawa A, Bhutani MS, et al. Significance of normal appearance on endoscopic ultrasonography in the diagnosis of early chronic pancreatitis. Endosc Ultrasound. 2018;7(2):110-118. Observational-Dx 177 patients To investigate the validity of a "normal" pancreas appearance and to evaluate the usefulness of modified diagnostic criteria in comparison to the traditional EUS criteria and the RC. (1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 out of 45 CP cases on ERP (P < 0.0001). (2) We investigated the diagnostic capability of our new criteria for endoscopic retrograde cholangiopancreatography normal/equivocal pancreas compared to the traditional criteria. In cases where fewer than two points were defined as normal, the incidence of normal pancreas was significantly higher based on the new criteria than on the traditional criteria (P = 0.002). (3) No significant differences were found between the new criteria and the RC across all ERP grades. 2
70. Yamashita Y, Tanioka K, Kawaji Y, et al. Endoscopic ultrasonography shear wave as a predictive factor of endocrine/exocrine dysfunction in chronic pancreatitis. J Gastroenterol Hepatol. 36(2):391-396, 2021 Feb. Observational-Dx 40 patients To evaluate the utility of EUS-SWM in diagnosing CP and determining exocrine and endocrine dysfunctions. The EUS-SWM value was positively correlated with the Japan Pancreatic Society criteria stages. The probable and definite CP groups had significantly higher EUS-SWM values than the normal group. The areas under the receiver operating characteristic curve for the diagnostic accuracy of EUS-SWM for CP, exocrine dysfunction, and endocrine dysfunction were 0.92, 0.78, and 0.63, respectively. The cut-off values of 1.96, 1.96, and 2.34 for diagnosing CP, exocrine dysfunction, and endocrine dysfunctions had 83%, 90%, and 75% sensitivity, respectively, and 100%, 65%, and 64% specificity, respectively. 3
71. Iglesias-Garcia J, Larino-Noia J, Nieto Bsn L, et al. Pancreatic Elastography Predicts Endoscopic Secretin-Pancreatic Function Test Result in Patients With Early Changes of Chronic Pancreatitis: A Prospective, Cross-Sectional, Observational Study. Am J Gastroenterol. 117(8):1264-1268, 2022 08 01. Review/Other-Dx 61 patients To evaluate whether EUS-E correlates with and could replace ePFT for the evaluation of patients with suspected CP. Sixty-one patients were included and analyzed. The mean peak bicarbonate concentration at the ePFT was 63.8 ± 23.6 mEq/L, and it was abnormally low in 50 patients (82.0%). The mean SR was 3.85 ± 1.24. Correlation between SR and bicarbonate secretion was highly significant ( r = 0.715, P &lt; 0.0001). Diagnostic accuracy of EUS-E for CP was 93.4%. 4
72. D'Aversa F, Ainora ME, Mignini I, et al. The Gemelli Ultrasound Chronic Pancreatitis Score: A Non-invasive Tool for the Diagnosis of Chronic Pancreatitis. Ultrasound Med Biol. 48(4):685-693, 2022 04. Review/Other-Dx 93 patients To evaluate the role of the Gemelli USCP score in the diagnosis of CP and the agreement with standard imaging techniques. Ninety-three patients clinically suspected of having CP and referred to the pancreatic outpatient clinic of A. Gemelli Hospital for endoscopic ultrasound (EUS) were prospectively enrolled. All patients underwent pancreatic US to calculate the Gemelli USCP score. A receiver operating characteristic curve analysis was also performed to assess the performance of the US score in CP diagnosis. The Gemelli USCP score was inversely related to the Rosemont score for both total value (p < 0.0001) and each parameter evaluated (p < 0.0001). This score was significantly higher in patients with CP with an excellent area under the receiver operating characteristic curve (0.946) and the optimal cutoff of 5. Moreover, we found a significant correlation between the Gemelli USCP score and laboratory parameters related to pancreatic exocrine insufficiency (p < 0.0001). The development of a dedicated ultrasound score could be useful as a non-invasive tool in the diagnosis of CP. 4
73. Ito T, Ikeura T, Tanaka T, et al. Magnetic resonance cholangiopancreatography findings in early chronic pancreatitis diagnosed according to the Japanese Diagnostic Criteria. Pancreatology. 20(4):596-601, 2020 Jun. Review/Other-Dx 165 patients To examine the pancreatic ductal changes on magnetic resonance cholangiopancreatography (MRCP) in patients with early CP defined by the Japanese Diagnostic Criteria. We enrolled 165 patients and 25 patients (15%) fulfilled the diagnostic criteria for early CP. Irregular dilatation of = 3 duct branches on MRCP was more often observed in early CP compared to non-early CP (P = 0.004), although MPD diameter was comparable (2.06 mm in early CP vs. 1.96 in non-early CP, P = 0.698). The sensitivity and specificity were 45% and 74%, respectively. The prevalence of positive MRCP findings in patients with = 2 positive EUS findings was higher than that in patients with 1 positive EUS finding (P = 0.08) and in patients without an EUS finding (P < 0.001). There was no difference in the average diameter of MPD. 4
74. Engjom T, Sangnes DA, Havre RF, et al. Diagnostic Accuracy of Transabdominal Ultrasound in Chronic Pancreatitis. Ultrasound Med Biol. 43(4):735-743, 2017 04. Observational-Dx 124 patients with suspected CP and 54 controls to evaluate the diagnostic accuracy of modern abdominal US compared with the Mayo score in CP. Diagnostic performance indices (95% confidence interval) of US were calculated: The unweighted count of features had a sensitivity of 0.69 (0.54-0.80) and specificity of 0.97 (0.90-1). The Rosemont score had a sensitivity of 0.81 (0.69-0.91) and specificity of 0.97 (0.90-1). Exocrine pancreatic failure was most pronounced in Rosemont groups I and II (p < 0.001). 3
75. Kawada N, Tanaka S. Elastography for the pancreas: Current status and future perspective. [Review]. World J Gastroenterol. 22(14):3712-24, 2016 Apr 14. Review/Other-Dx N/A To introduce literature on the different elastographies for the pancreas. No results in abstract. 4
76. Saftoiu A, Vilmann P, Dietrich CF, et al. Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc. 82(1):59-69, 2015 Jul. Observational-Dx 167 consecutive patients with PC or CP To validate the use of parameters derived from TIC analysis in an artificial neural network (ANN) classification model designed to diagnose pancreatic carcinoma (PC) and chronic pancreatitis (CP). After excluding all of the recordings that did not meet the technical and procedural criteria, 112 cases of PC and 55 cases of CP were included. EUS-FNA was performed in 129 patients, and the diagnosis was confirmed by surgery (n = 15) or follow-up (n = 23) in the remaining cases. Its sensitivity and specificity were 84.82% and 100%, respectively, whereas the PPV and NPV were 100% and 76.63%, respectively. The sensitivity of real-time quantitative assessment of CEH-EUS was 87.5%, specificity 92.72%, PPV 96.07%, and NPV 78.46%. Peak enhancement, wash-in area under the curve, wash-in rate, and the wash-in perfusion index were significantly different between the groups. No significant differences were found between rise time, mean transit time, and time to peak. For the ANN, sensitivity was 94.64%, specificity 94.44%, PPV 97.24%, and NPV 89.47%. 3
77. Shanbhogue KP, Pourvaziri A, Jeyaraj SK, Kambadakone A. Endoscopic and surgical treatment options for chronic pancreatitis: an imaging perspective. [Review]. Abdom Radiol. 45(5):1397-1409, 2020 05. Review/Other-Dx N/A To summarize the most common surgical and endoscopic treatment options that are currently available for chronic pancreatitis, including the implications on imaging. No results in abstract. 4
78. Sandrasegaran K, Heller MT, Panda A, Shetty A, Menias CO. MRI in acute pancreatitis. Abdom Radiol (NY). 2020 May;45(5):1232-1242. Review/Other-Dx N/A To discuss these specific uses of MRI in acute pancreatitis. No results stated in abstract. 4
79. Turkvatan A, Erden A, Turkoglu MA, Secil M, Yener O. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis. [Review]. Diagn Interv Imaging. 96(2):151-60, 2015 Feb. Review/Other-Dx N/A To present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality. Results not stated in abstract 4
80. Kaczmarek DJ, Nattermann J, Strassburg CP, Weismuller TJ. Endoscopic Ultrasound-Guided Drainage and Treatment of Symptomatic Pancreatic Fluid Collection following Acute or Acute-on-Chronic Pancreatitis - A Single Center Case Series. Zentralbl Chir. 143(6):577-585, 2018 Dec. Observational-Dx 41 consecutive patients with post-pancreatitic pancreatic fluid collection (PFC) To determine retrospectively the short- and long-term results of patients treated in our endoscopy unit and to identify parameters that are associated with treatment efficacy and outcome. The mean diameter of the PFC was 74.0 ± 4.8 mm. Of the PFCs, 29.3% were classified as PP and 70.7% as WON. Altogether, 196 transmural endoscopic procedures were performed, including 73 endoscopic necrosectomies in a subgroup of 21 patients (20 WON, 1 PP). Initial technical success was achieved in 97.6% of patients and the short-term clinical success rate was 90.2%. The long-term clinical success rate was 82.9%, since four patients died from septic shock and/or multiple organ failure and three patients developed recurrent PFC some months after the initial discharge from endoscopic treatment. Procedural complications were registered in 9 patients during 10 of 196 endoscopic procedures (5.1%): bleeding (6), cardiorespiratory insufficiency (2), perforation with pneumoperitoneum (1), aspiration with respiratory insufficiency (1), and non-perforating superficial damage of the gastric wall (1). Neither the size of the PFC nor the initial value of C-reactive protein (CRP) or other biochemical markers were correlated with efficacy or outcome of treatment. Only the cumulative number of days with CRP > 50 mg/L significantly correlated with the number of follow-up endoscopic sessions and DEN. Fungal colonization of PFC correlated significantly (p < 0.05) with the risk of mortality (44% vs. 0%), need for intensive care treatment (66.7% vs. 25%), and sepsis (55.6% vs. 12.5%). 3
81. Fung C, Svystun O, Fouladi DF, Kawamoto S. CT imaging, classification, and complications of acute pancreatitis. Abdom Radiol (NY). 2020 May;45(5):1243-1252. Review/Other-Dx N/A To provide sample CECT technical acquisition parameters for pancreatic imaging. No results stated in abstract. 4
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