Pancreatitis: computed tomography and magnetic resonance imaging

The value of CT in management of severe acute pancreatitis is well establis hed. Some, but not all, experimental studies suggest a detrimental effect o f intravenous iodinated contrast agents in acute pancreatitis, but although initial clinical data tends to support this, the positive advantages of en hanced CT outweigh the possible risks. Magnetic resonance imaging has been shown to be as effective as CT in demonstrating the presence and extent of pancreatic necrosis and fluid collections, and probably superior in indicat ing the suitability of such collections for percutaneous drainage. Image-gu ided intervention remains a key approach in the management of severely ill patients, and the indications, techniques and results of radiological inter vention are reviewed herein. Both CT and MRI can be used to diagnose advanc ed chronic pancreatitis, with the recent addition of MRCP as a viable alter native to diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Both MRCP and CT/MR imaging of the pancreatic parenchyma still have limita tions in the re-cognition of the earliest changes of chronic pancreatitis - for which ERCP and tests of pancreatic function remain more sensitive - bu t the clinical significance of these minor changes remains contentious.