慢性胰腺炎及并发症课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,MRI of Pancreatitis and Its Complications: Chronic,Pancreatitis,宋承汝 2013,.6.5,慢,性胰腺炎及其并发症的MRI表现,Chronic pancreatitis is an inflammatory disease characterized by progressive and irreversible structural damage to the pancreas resulting in permanent impairment of both exocrine and endocrine functions. ERCP is the gold standard for early chronic pancreatitis, but it is invasive. MRI may be an alternative for patients in whom CT or ERCP is contraindicated or not tolerated.,MRI provides noninvasive biliary and pancreatic duct imaging and accurate characterization of pancreatic and peripancreatic pathology.慢性胰腺炎是一种炎症性疾病，其特征,是对,胰腺逐步和不可逆转的结构性损坏，导致外分泌和内分泌功能的永久性,受损,。 ERCP是,诊断,早期慢性胰腺炎的金标准，但它是侵入,性检查,。 在CT或ERCP,为,禁忌或不能耐受,时，,MRI可,作为,替代。MRI提供非侵入性胆胰管成像和胰腺及胰周病变的,征象,。,The diagnosis of chronic pancreatitis on MRI is based on signal intensity and enhancement changes as well as on morphologic abnormalities in the pancreatic parenchyma, pancreatic duct, and biliary tract. The imaging features of chronic pancreatitis can be divided into early and late findings.,慢性胰腺炎MRI诊断是基于信号强度和增强的变化，以及胰腺实质，胰管和胆道形态的异常。慢性胰腺炎的影像特征可分为早期,表现,和晚期表现。,Early findings include low-signal-intensity pancreas on T1-weighted fat-suppressed images, decreased and delayed enhancement after IV contrast administration, and dilated side branches. Late findings include parenchymal atrophy or enlargement, pseudocysts, and dilatation and beading of the pancreatic duct often with intraductal calcifications.,早期,表现,包括T1加权脂肪抑制图像,上呈,低信号，,延迟强化或强化程度减低,，侧支,扩张,。晚,期表现,包括实质萎缩或肿大，假性,囊肿，,胰管,扩张或呈串珠样，,导管内,常伴,钙化。,MRI allows early recognition of chronic pancreatitis based on changes in pancreatic signal intensity; these changes are best visualized on unenhanced and gadolinium-enhanced T1-weighted fat-suppressed images (Fig.,1A,1B,1C,1D,).,MRI可以早期识别慢性胰腺炎胰腺信号强度的变化，平扫和增强T1加权脂肪抑制图像,显示信号变化最佳,（图1A，1B，1C，1D）。,Fig.1A. 1B.,Fig. 1A. 24-year-old woman with small pancreatic duct stone causing duct obstruction and segmental pancreatitis. Axial T2-weighted HASTE image shows slightly increased signal intensity of pancreatic tail (,arrow,) with mild dilatation of pancreatic duct.Axial T1-weighted fat-suppressed spoiled gradient-echo image shows abnormal low signal intensity of pancreatic tail (,arrow,) while remainder of pancreas has normal bright signal intensity.,24岁,，,女,。,小胰管结石引起胆道梗阻和节段性胰腺炎。,T2WI胰尾信号轻度升高，胰管轻度扩张,（箭头）。,T1WI,显示胰尾,异常低信号,（箭头），,胰腺其余部分,信号强度正常,，为高信号。,Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during arterial phase shows delayed enhancement of pancreatic tail (,arrow,) relative to normal pancreas due to fibrosis. Patient later developed atrophic changes in this area that led to resection of pancreatic tail.Contrast-enhanced CT scan shows punctate high-density focus (,arrow,) in pancreatic duct representing small intraductal stone. This example illustrates the advantage of CT in showing tiny intraductal stone that was not seen on MRI. It, however, also illustrates the advantage of MRI in showing changes of signal intensity associated with chronic pancreatitis that are not visible on CT.,动脉期,增强T1WI,示因纤维化胰尾,较正常胰腺,强,化,延迟（箭头），,此处后来呈萎缩性改变，,导致,实行,胰尾切除术。对比增强CT扫描显示,胰管内,小结石。这个例子说明了CT的优势在于显示微小的管内结石，而在MRI未显示。然而，它也,显,示出磁共振成像的优点,：可显,示出慢性胰腺炎信号强度的变化与关系，,此,在CT上是不可见的。,Fig.1C.1D.,Chronic inflammation and fibrosis diminish the proteinaceous fluid content of the pancreas, resulting in the loss of the usual high signal intensity on T1-weighted fat-suppressed images. The normal pancreas enhances uniformly and intensely on early arterial phase contrast-enhanced T1-weighted images and exhibits rapid washout of gadolinium on subsequent images.,慢性炎症和纤维化减少胰腺的蛋白质含量，,使得,在T1加权脂肪抑制图像,上高,信号,消失,。正常胰腺,动脉期,均匀,明显强化，并快速廓清,。,In contrast, a pancreas with chronic fibrosis and glandular atrophy exhibits decreased and heterogeneous enhancement on early arterial phase images and increased relative enhancement on delayed images (Fig.,2A,2B,2C,).,相比之下，慢性纤维化,并,腺体萎缩,的胰腺在早动脉期强化程度减低并强化不均匀，延迟图像上强化程度相对升高,（图2A，2B，2C）,Fig. 2A.,2B.,Fig. 2A.,46-year-old man with history of chronic pancreatitis due to alcohol abuse. Axial T1-weighted fat-suppressed spoiled gradient-echo image shows atrophy of pancreatic parenchyma and irregular dilatation of main pancreatic duct (,arrows,), changes suggestive of chronic pancreatitis. Calcifications are not as well seen on MRI as on CT.Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during arterial phase shows diffusely decreased pancreatic enhancement relative to marked enhancement seen normally. This decreased enhancement relates to fibrosis due to chronic pancreatitis. Dilated pancreatic duct (,arrows,) is visualized more clearly after contrast administration.,46岁,，,男,，,因酗酒,致慢性胰腺炎,。,T1WI,显示胰腺实质的萎缩和不规则扩张的主胰管（箭头），提示慢性胰腺炎的变化。钙化在MRI和CT上都没有看到。,动脉期增强T1WI,显示,胰腺因慢性炎症引起的纤维化而强化,弥漫性降低,，而非,通常看到的显,著,增强。胰管扩张（箭头）,显示更清,。,Duct Abnormalities胰管异常,MRCP is highly accurate for identifying pancreas divisum (,Fig. 6,). However, its association with pancreatitis remains controversial. Duct abnormalities such as dilatation, irregularity, and stones and complications of chronic pancreatitis such as pseudocysts are best depicted by thin-section T2-weighted HASTE or single-shot fast spin-echo and thick-slab T2-weighted half-Fourier RARE MRCP images.,MRCP,发现,胰腺分裂,的准确度很高,（图6）。然而，它与胰腺炎,的关系,仍存在争议。,胰,管异常，如扩张，不规则，,结,石和并发症如假性,囊肿，在,薄,层,T2加权,HASTE,或MRCP,显示最佳。,Fig. 6. 53-year-old woman with history of cholecystectomy who presented with jaundice, abnormal results on liver function tests, and pancreas divisum. Axial T2-weighted image shows noncommunicating main pancreatic duct (straight arrow) and accessory duct (curved arrow) draining separately into duodenum.,图6,，,53,，,女,。胆囊切除术后，黄疸，肝功能异常，胰腺分裂症。轴位T2WI显示,轴向T2加权图像显示，互不沟通的主胰管（直箭头）和配,胰,管（弯箭头）分别进入十二指肠引流。,Fig.,6,.,MRCP is accurate in depicting strictures of the pancreatic duct or biliary tract (,Fig. 7,). In equivocal cases, ductal distention by contrast injection during ERCP may be helpful. The beaded main pancreatic duct with its dilated side branches may have a chain-of-lakes appearance when more extensive (,Fig. 8,).,MRCP,可,准确的描绘胰管或胆管的狭窄（图7）。在模棱两可的情况下，在ERCP,过程中,导管注射造影剂,扩张胰胆管,可能会有帮助。,当病变广泛时，,串珠,样,主胰管,和,扩张,的,侧枝，,可能有连锁湖样改变,。,Fig. 7. 62-year-old woman with history of chronic pancreatitis and pseudocysts. Coronal T2-weighted thick-slab RARE image shows stricture (straight arrow) of pancreatic duct at level of pancreatic head. Upstream pancreatic duct is dilated and irregular, and there is mild dilatation of side branches. Note diverticulum (curved arrow) arising from duodenum.,图7。 62,，,女,。,慢性胰腺炎,，假性囊肿,。冠状T2,WI,显示胰头水平胰管狭窄（直箭头）。上游胰管不规则扩张，,侧枝,轻度扩张。注意十二指肠憩室（弯箭头）。,Fig.,7,.,Fig. 8. 69-year-old man with chronic pancreatitis. Axial T2-weighted HASTE image shows irregular dilated main pancreatic duct and side branches giving chain-of-lakes appearance. Note atrophic changes in pancreas and signal-void areas (arrows) related to calcifications from chronic pancreatitis.,图8。69岁,，,男,。,慢性胰腺炎。轴向T2,WI,显示不规则,扩张,的主胰管和侧枝,，,连锁湖外观。,可见胰腺,萎缩,及无,信号,钙化,区（箭头）。,Fig.,8,.,CT is more sensitive than MRI for the detection of calcifications associated with chronic pancreatitis; however, MRI best depicts intraductal stones and duct obstruction (Figs. 9A, 9B and 10). Unlike ERCP, MRCP can show the dilated duct upstream from an obstructing stone. Nevertheless, visualizing intraductal stones not surrounded by fluid may be difficult on MRI (Fig. 1A, 1B, 1C, 1D).,对,慢性胰腺炎的钙化,检测，,CT比MRI敏感，,然而,，,MRI显,示管内,结石,和,胰胆管,阻塞,最佳,（图9A，9B和10）。不同于ERCP，MRCP能显示上游扩张导管。然而，MRI,诊断,不,被液体,包围的导管内,结,石困难（图1A，1B，1C，1D）。,Fig. 9A. 46-year-old man with history of chronic pancreatitis due to alcohol abuse. Axial contrast-enhanced CT scan shows multiple calcifications in pancreatic head. It is difficult to determine that a stone is in pancreatic duct. Calcifications are seen commonly in chronic alcohol-related pancreatitis, as in this patient.Axial T2-weighted HASTE image shows stone (arrow) in main pancreatic duct delineated by high-signal-intensity fluid.,图9A。 男,，,46岁,。,酗酒史,，,慢性胰腺炎。轴向增强CT扫描显示胰头,多发钙化,。,从CT,很难确定胰管,内有无结石,。钙化,在,慢性酒精相关性胰腺炎,中很常见,，,此例即如此,。轴向T2,WI,的显示主胰管,内结石,（箭头）,被,高信号,液体包绕,。,Fig.,9A,.,9B.,Fig. 10. 45-year-old woman with history of abdominal pain. Coronal T2-weighted HASTE image shows pancreatic duct stone (straight arrow) and gallstone (curved arrow). GB = gallbladder, CBD = common bile duct, PD = pancreatic duct, DUOD = duodenum.,图10。 45岁,，,女,，,腹痛。冠状T2,WI,的显示胰管,内,结石（直箭头）,和,胆结石（弯箭头）。 GB =胆囊，CBD =胆总管，PD =的胰管，DUOD =十二指肠。,Fig.,10.,Complications,1.Pseudocysts 假性囊肿,2.,Vascular,血管相关并发症,3.,Biliary,胆管相关并发症,1.Pseudocysts,Pseudocysts are encapsulated collections of pancreatic secretions that occur in or around the pancreas. Although most resolve spontaneously, complications such as infection, hemorrhage, and gastric or biliary obstruction may occur (Fig. 11A, 11B). Pseudocysts can be communicating with the main pancreatic duct (Fig. 12) or noncommunicating . MRI can depict pseudocysts and can be used to characterize their content and thus to guide drainage.,假性,囊肿是,发生在胰腺,内或胰腺,周围,被包裹的,胰腺分泌物。虽然大多数,可,自发,吸收,，,但也可发生,并发症，如感染，出血，胃或胆道梗阻（图11A，11B）。假性囊肿与主胰管,可,连通（图12）或,不连通,（图13）。MRI可以描绘假性,囊肿并检测内容物成分以指导引流,。,52-year-old man with history of recurrent pancreatitis. Axial T2-weighted HASTE image shows large thick-walled multiloculated cystic collection located primarily in lesser sac, representing pseudocyst (P). It does not communicate with pancreatic duct.Axial T1-weighted fat-suppressed spoiled gradient-echo image shows high-signal-intensity fluid within pseudocyst, suggestive of complicated pseudocyst (P). Internal consistency of pseudocysts may be altered because of presence of proteinaceous material, hemorrhage, or infection, and it may require prompt drainage.,52岁,，,男,，,复发性胰腺炎。轴向T2,WI,的显示主要位于小网膜囊,的巨,大厚壁多房,假性囊肿,(P)。不,与,胰管沟通。 轴,位,T1,WI,显示,囊肿内为,高信号，,提示其为,复杂,性假性囊肿,（P）。因存在蛋白,性,物质，出血，或感染，,假性囊肿,内部一致性可被改变，,提示,需要,尽快引流,。,Fig.,11A.11B.,Fig. 12. 55-year-old woman with abdominal pain, weight loss, and history of pancreatitis. Axial T2-weighted HASTE image shows high-signal-intensity pseudocyst (P) in pancreatic head with dilated and irregular pancreatic duct. Pseudocyst can be seen communicating with main pancreatic duct (arrow).,图12。 55岁,，,女,。,腹痛，体重减轻，胰腺炎。轴,位,T2,WI,显示,胰头部,高信号假性,囊肿,（P）,及,不规则扩张,的胰管,。可以看出,假性囊肿,与主胰管（箭头所示）,连通,。,Fig.,12,2.,Vascular,Arterial pseudoaneurysms, hemorrhage into pseudocysts, arterial bleeding, and splenic or portal vein thrombosis are vascular complications of chronic pancreatitis that may be seen on MRI. In patients with chronic splenic vein thrombosis, the vein may not be visualized. (Fig. 14A, 14B).,假性动脉瘤，,假性囊肿内出血,，,出血，,脾,静脉或,门静脉血栓,为慢性胰腺炎的,血管,相关,并发症,，MRI可检测出,。,但当有慢性脾静脉血栓时，静脉可能无法显示,（图14A，14B）,Fig. 14A. 46-year-old man with history of chronic pancreatitis due to alcohol abuse. Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during venous phase shows chronic occlusion of portal vein with collaterals (arrow): cavernous transformation of portal vein.,Fig.B,shows collateral vessels (arrows), which is suggestive of splenic vein occlusion.,46岁,，,男,，,慢性胰腺炎,，,酗酒史。,静脉期,轴向增强T1,WI,示,门静脉慢性闭塞,（箭头）,呈,海绵样变。,图B,显示侧支,循环形成,（箭头），提示脾静脉阻塞。,Fig.,14A.B.,3.,Biliary,The biliary complications of chronic pancreatitis include choledocholithiasis, fistulas, and dilatation of the common bile duct due to inflammatory strictures. The typical appearance of benign strictures on MRCP is gradual tapering with a funnellike narrowed segment (Fig. 15).,慢性胰腺炎的胆道并发症，,包括,胆总管结石，瘘管，由于炎性狭窄,而致的,胆总管扩张。 良性狭窄,的,典型MRCP,表现为逐渐变细的漏斗样狭窄,（图15）。,Fig. 15. 59-year-old man with history of chronic pancreatitis. MR image was obtained to evaluate biliary tract and complex pseudocysts seen on prior CT scan (not shown). Coronal T2-weighted thick-slab RARE image shows dilated common bile duct with funnel-shaped narrowing (arrowhead),.,Pancreatic duct is dilated and contains calculus (arrow) at pancreatic head level. Also seen are multiple pseudocysts (P) extending both superior and inferior to pancreas. GB = gallbladder.,男，59岁，明显胰腺炎。行MRI检测以明确CT所示复杂假性囊肿并评价胆道情况。,冠状T2,WI,显示,扩张的胆总管、漏斗样狭窄（箭头）。胰管扩张、胰头处可见结石。并可见多发,假性囊肿（P）,延伸至胰腺前后方,。 GB =胆囊。,Fig.,15,Chronic Pancreatitis V,S.,Pancreatic Carcinoma,慢性胰腺炎 VS. 胰腺肿瘤,Chronic Pancreatitis V,S.,Pancreatic Carcinoma,Differentiating between an inflammatory mass due to chronic pancreatitis and pancreatic carcinoma on the basis of imaging criteria remains difficult. Decreased T1 signal intensity with delayed enhancement after gadolinium administration as well as dilatation and obstruction of the pancreaticobiliary ducts can be seen in both diseases . Irregularity of the pancreatic duct, intraductal or parenchymal calcifications, diffuse pancreatic involvement, and normal or smoothly stenotic pancreatic duct penetrating through the mass (“duct penetrating sign”) favor the diagnosis of chronic pancreatitis over cancer (Fig. 16A, 16B, 16C). In distinction, a smoothly dilated pancreatic duct with an abrupt interruption, dilatation of both biliary and pancreatic ducts (“double-duct sign”), and obliteration of the perivascular fat planes favor the diagnosis of cancer.,鉴别,慢性胰腺炎,引发的炎性包块,和胰腺,肿瘤，从影像学上尚属困难,。,两者均可出现延迟强化和胰胆管的阻塞扩张,。,不规则的,胰管，胰管内或实质,内,钙化，弥漫性胰腺受累，,光滑狭窄的胰管从肿块内穿过,（“穿透,症,”）,更支持,慢性胰腺炎的诊断（图16A，16B ，16C）。,相反的，平滑扩张的,胰管突然中断，胆,管,和胰管,同时扩张,（“双管征”），以及血管周围脂肪,间隙消失则支持肿瘤,的诊断。,Fig. 16A. 58-year-old woman with breast cancer and chronic pancreatitis related to alcohol abuse. Patient had 50-lb (23-kg) weight loss. ERCP image (not shown) revealed stone in pancreatic duct, which was removed. Fine-needle aspiration was suggestive of adenocarcinoma. Whipple procedure indicated chronic pancreatitis without cancer. Axial T1 fat-suppressed spoiled gradient-echo image shows low-signal-intensity pancreas due to chronic pancreatitis.Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during arterial phase shows diffusely decreased enhancement of pancreas due to chronic pancreatitis. Note dilated pancreatic duct.,图16A。 58岁,，,女，乳腺癌,、,酗酒,相,关的慢性胰腺炎。,发病以来体重下降23kg,。 ERCP图像（图中未示出）显示胰管石,并去,除。细针穿刺提示腺癌。胰十二指肠切除术,提示慢性胰腺炎无癌变。,轴向T1,WI,显示,因慢性胰腺炎而呈低信号的胰腺。,动脉期,增强T1,WI,示胰腺弥漫性,强化减低,。注意胰管扩张。,Fig.,16A.B.,Fig. 16C. Axial T2-weighted HASTE image shows markedly dilated main pancreatic duct (arrow) penetrating through pancreas with chronic inflammatory and fibrotic changes: “duct penetrating sign.” This finding suggests chronic pancreatitis over adenocarcinoma.,图16C。,同一病例。,轴向T2,WI,示明显扩张的主胰管（箭头），穿,过具有,慢性炎症和纤维化的,胰腺：,“穿透,征,”,。,这一,征象提示慢性胰腺炎可能性大。,Fig.,16C.,MRI may be superior to MDCT for the evaluation of pancreatic adenocarcinoma, especially if the lesion is small and non-contour-deforming. The tumor is best delineated on unenhanced T1-weighted fat-suppressed images and multiphasic enhanced sequences (Fig. 17A, 17B, 17C, 17D).,MRI,在对,胰腺,腺,癌的,诊断上,优于MDCT，特别是病变,较小且胰腺外形没有异常时,。,平扫T1WI及多期增强序列上,图17A，17B，17C，17D）,显示最佳,。,71-year-old woman with weight loss due to adenocarcinoma of pancreas with associated chronic pancreatitis. Axial contrast-enhanced CT scan shows atrophy of pancreatic tail and duct dilatation (arrow) to level of suspected mass, which is difficult to see.Axial T2-weighted HASTE image shows dilatation of pancreatic duct with abrupt termination (arrow) due to tumor.,71岁,，,女,。慢性胰腺炎并腺癌,。轴向增强CT示胰尾,萎缩,和,胰,管扩张（箭头,），无法判断是否有肿块,。轴向T2,WI,示由于肿瘤,扩张的,胰管突然终止（箭头）。,Fig.,17A.B.,Fig. 17C. Axial T1-weighted fat-suppressed spoiled gradient-echo image shows low-signal-intensity mass (arrowhead), measuring less than 1 cm. Note atrophy and decreased signal intensity of pancreatic tail (curved arrow) related to associated chronic pancreatitis. Normally high signal intensity of pancreatic head (straight arrow) is preserved.Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during late venous phase shows delayed enhancement of tumor (arrowhead). This example shows value of MRI to depict nondeforming pancreatic mass .,同一病例，,轴向T1,WI,示,低信号肿块,（箭头），小于1厘米。注意,慢性胰腺炎引起的胰尾信号减低并,萎缩（弯箭头）。胰头,仍为正常高信号,（直箭头）。,静脉期,轴向增强T1,WI,示延迟强,化的,肿瘤（箭头）。这个例子显示MRI,在诊断不伴有胰腺外形失常的胰腺肿瘤中的价值。,Fig.,17C.D.,Groove Pancreatitis,沟部胰腺炎,Groove pancreatitis is a type of focal chronic pancreatitis affecting the groove between the head of the pancreas, duodenum, and common bile duct. The predominant MRI finding of groove pancreatitis is a sheetlike fibrotic mass between the pancreatic head and thickened duodenal wall associated with duodenal stenosis and cystic changes in the duodenal wall (Fig. 18A, 18B, 18C, 18D). The recognition of groove pancreatitis is important for differentiation from pancreatic and duodenal carcinomas .,沟部,胰腺炎,（胰头部慢性局限性胰腺炎）,是一种局灶性慢性胰腺炎,，发生于,胰,头、,十二指肠,、,胆总管之间的凹槽,内,。,沟部,胰腺炎的主要MRI,为,胰头及增厚,的,十二指肠壁,之间片状的纤维化肿块，同时,伴有十二指肠狭窄和十二指肠壁,的,囊性改变（图18A，18B，18C，18D）。,提高对沟部,胰腺炎,的认识在,胰腺和十二指肠,肿瘤,的,鉴别诊断中,是非常重要的。,Fig. 18A. 57-year-old man with 2-year history of chronic pancreatitis and groove pancreatitis. Contrast-enhanced CT scan shows solid mass with small low-density cystic lesion (arrow) lying in groove between head of pancreas (P) and duodenum (D). Axial T1-weighted fat-suppressed spoiled gradient-echo image shows low-signal-intensity mass (arrow) containing small cystic component and lying between high-signal-intensity pancreatic head (P) and duodenum.,图18A。 57岁,，,男,。,慢性胰腺炎,和沟部,胰腺炎2年。对比增强CT示胰头（P）和十二指肠（D）间,的凹槽内实性肿块，肿块内可见,小囊性低密度病,灶,（箭头）。轴向T1,WI,示含小囊性成分,的,低信号肿块（箭）,位于,高信号,的胰头,（P）和十二指肠之间。,Fig.,18A.B.,Fig. 18C. 57-year-old man with 2-year history of chronic pancreatitis and groove pancreatitis. Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during arterial phase shows normal enhancement of pancreas and duodenal wall. Heterogeneous mass (arrow) has decreased enhancement due to fibrosis.Axial enhanced T1-weighted fat-suppressed spoiled gradient-echo image obtained during venous phase shows delayed enhancement of heterogeneous mass (arrow) in groove due to fibrosis. P = pancreatic head.,图18C。,同一病例。动脉期,轴向增强T1,WI,示胰腺和十二指肠壁,正常,强,化。不均质肿块因纤维化而呈低强化,（箭）。,静脉期,图像示,肿块,延迟强化（箭头）。 P =胰头。,Fig.,18C. D.,Conclusion,Patients with suspected chronic pancreatitis may benefit from undergoing MRI as an adjunct or alternative to ERCP and CT. In particular, MRI may be useful in the evaluation for strictures, anatomic variants, and dilatation of the pancreatic duct and for associated fluid collections.,疑似慢性胰腺炎患者,可以,MRI,检查,作为一种,对,ERCP和CT辅助或替代。MRI可,有效,评,估,狭窄，解剖变异，胰管扩张,及液,体,积聚,。,Thanks for your attention!,