Pancreatic Ultrasound: State of the Art.

An ultrasound (US) study is often the first imaging approach in patients with abdominal symptoms or signs related to abdominal diseases, and it is often part of the routine workup. The pancreatic gland, despite its retroperitoneal site, can be efficiently examined with US thanks to advances in US technologies. Nowadays, a pancreatic US study could be considered complete if multiparametric, including the use of Doppler imaging, US elastography, and contrast-enhanced imaging for the study of a pancreatic mass. A complete US examination could contribute to a faster diagnosis, especially if the pancreatic lesion is incidentally detected, addressing second-step imaging modalities correctly.

Secretin-stimulated MRI characterization of pancreatic morphology and function in patients with chronic pancreatitis.

BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) is characterized by abnormal pancreatic morphology and impaired endocrine and exocrine function. However, little is known about the relationship between pancreatic morphology and function, and also the association with the etiology and clinical manifestations of CP. The aim was to explore pancreatic morphology and function with advanced MRI in patients with CP and healthy controls (HC) METHODS: Eighty-two patients with CP and 22 HC were enrolled in the study. Morphological imaging parameters included pancreatic main duct diameter, gland volume, fat signal fraction and apparent diffusion coefficient (ADC) values. Functional secretin-stimulated MRI (s-MRI) parameters included pancreatic secretion (bowel fluid volume) and changes in pancreatic ADC value before and after secretin stimulation. Patients were classified according to the modified Cambridge and M-ANNHEIM classification system and fecal elastase was collected. RESULTS: All imaging parameters differentiated CP patients from HC; however, correlations between morphological and functional parameters in CP were weak. Patients with alcoholic and non-alcoholic etiology had comparable s-MRI findings. Fecal elastase was positively correlated to pancreatic gland volume (r = 0.68, P = 0.0016) and negatively correlated to Cambridge classification (r = -0.35, P < 0.001). Additionally, gland volume was negatively correlated to the duration of CP (r = -0.39, P < 0.001) and baseline ADC (r = -0.35, P = 0.027). When stratified by clinical stage (M-ANNHEIM), the pancreatic gland volume was significantly decreased in the severe stages of CP (P = 0.001). CONCLUSIONS: S-MRI provides detailed information about pancreatic morphology and function and represents a promising non-invasive imaging method to characterize pancreatic pathophysiology and may enable monitoring of disease progression in patients with CP.

Physiological and Histological Changes in Pancreatic Gland Associated with Ageing in Local Rabbits in Iraq.

The pancreas is a pear-shaped flat organ resembling the letter L, and yellowish to pink in color. This organ is of medical significance since it is associated with two life-threatening diseases including diabetes mellitus and pancreatic cancer. This study was conducted on male rabbits which were assigned into 3 age groups (6-month-old, 1-year-old, and 3-year-old rabbits). Physiological and histological changes of the pancreas were studied in the adopted age groups. The physiological aspect and the histological structure of the pancreas were also studied by the analysis of the level of pancreatic gland hormones and hormonal changes. Based on the results, there were significant differences in the concentration of pancreatic gland hormones. Insulin level in the second study group was more than that in the first and third groups, while the highest concentration of blood sugar (glucose) was observed in the third group, compared to the first and second. Although the basic structure of the pancreas was similar in all samples, changes were observed in the tissue structure of the pancreas throughout the process of aging. By the increase of age (from 1 to 3 years old), Langerhans islets increased in size, contained alpha and beta cells that were surrounded by a loose connective tissue in the third stage. Moreover, no significant difference was observed in the diameters of cells that produced enzymes at all stages of life. Physiological and histological changes indicated that age plays a role in the function and structure of the pancreas gland during different stages of life. In addition, this study indicated that the hormonal variability of the pancreas is closely related to the histological composition of gland components. Therefore, further studies on the role of factors, such as gender, different breeds, or environmental conditions seem to be necessary and may provide more information on factors that may affect the effectiveness and activity of the pancreas gland.

Distribution and correlation of pancreatic gland size and duct diameters on MRCP in patients without evidence of pancreatic disease.

PURPOSE: To use MRCP to investigate age-related changes and gender differences of the pancreas and to correlate pancreatic gland size and duct diameter. METHODS: In this institutional review, board-approved, HIPAA-compliant study, 280 patients (age 20-88 years) without a history of pancreatic or liver disease who had undergone MRI/MRCP from 2004 to 2015 were identified. The anteroposterior size and main duct diameter of the pancreatic head, body, and tail were measured. The pancreatic gland and duct sizes were compared between genders, and among seven age subgroups (20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80-89). RESULTS: The pancreatic head and body were significantly larger in males than females (head, p < 0.01; body, p = 0.03), while the tail and the duct diameters of the pancreatic head, body, and tail showed no gender difference. As the age of male participants increased, there was an associated increase in size of the pancreatic gland initially (largest at age 50-59 (body) and 60-69 (head)), followed by subsequent decline in size thereafter. Additionally, the pancreatic duct diameter was found to increase gradually. In females, the size of the pancreatic gland decreased, while the diameter of the pancreatic duct increased with age. Moderate positive correlation for gland size and strong positive correlation for duct diameter among different pancreatic regions were found. Weak negative correlation was found between gland size and duct diameter. CONCLUSIONS: There are gender differences in the gland size of the pancreatic head and body. The pancreatic gland size increases until the sixth decade in males, with a more continuous decrease in gland size with age in females. Both males and females demonstrate a marked decrease in gland size after the eighth decade. The duct diameter increases with age in both males and females.