Lévy Philippe
Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon-92118 Clichy Cedex.
Bull Acad Natl Med. 2012 Dec;196(9):1785-800; discussion 1801-2.
Imaging methods are crucial for investigating the pancreas, a deep-seated organ. Technical and analytical parameters must be optimized for accurate interpretation. Thin-slice CT and pancreatic MRI are the principal methods, while endoscopic ultrasonography is a second-line procedure. The concept of familial (syndromic or non syndromic) pancreatic cancer has emerged in recent years, leading to complex management decisions. Genetic counseling is poorly developed in this specific setting, and the place of prophylactic total pancreatectomy remains to be established. Better knowledge of intraductal papillary neoplasms of the pancreas (IPMN) has led to a revolution in pancreatology. IPMN is frequent and may soon emerge as a public health problem. Its natural history is well known in the medium term (<10 years) but not in the longer term. A careful workup is necessary before choosing between pancreatic resection and watchful waiting. Autoimmune chronic pancreatitis (AICP) is a problem of internal medicine. AICP has a pseudo-tumoral aspect in 30% of cases. Diagnosis relies on a body of evidence, particularly imaging data and the clinical context. AICP is usually highly steroid-sensitive.