Department of Radiology, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Abdom Radiol (NY). 2020 May;45(5):1488-1494. doi: 10.1007/s00261-020-02522-6.
In the diagnosis of chronic pancreatitis (CP), definition of main pancreatic duct (MPD) dilation is challenging due to lack of commonly accepted normal values. This study assessed the diagnostic performance of MPD diameters to detect CP including the impact of age.
274 patients with ERCP-verified CP and 262 healthy controls were included. All had magnetic resonance cholangiopancreatography (MRCP) with measurement of MPD diameters in the pancreatic head, body, and tail. CP disease stage was defined as patients with and without functional (exocrine and/or endocrine) impairment. Diagnostic performance of MPD diameter and corresponding cut-offs values to diagnose CP were determined, including an age-stratified analysis.
In healthy controls, an effect of age on MPD diameters was seen for the pancreatic head (P < 0.001), body (P = 0.006), and tail (P = 0.03). Patients with CP had increased MPD diameter compared to controls (all segments P < 0.001). Increased pancreatic head MPD diameter was seen in patients with functional pancreatic impairment compared to patients without (P = 0.03). The diagnostic performance of MPD diameter to detect CP was high (all segments ROC-AUC > 0.92). The optimal pancreatic MPD diameter cut-off values for diagnosing CP were: < 40 years: 2.0(head) and 1.8(body) mm; 40-60 years: 2.4(head) and 2.1(body) mm; > 60 years: 2.7(head) and 2.1(body) mm.
Age is an important factor when evaluating the diameter of the pancreatic ductal system. Our findings challenge the existing reported thresholds for defining an abnormal duct diameter and point at age-stratified assessments as an integrated part of future imaging-based diagnostic and grading systems for CP.
在慢性胰腺炎（CP）的诊断中，由于缺乏普遍接受的正常值，主胰管（MPD）扩张的定义具有挑战性。本研究评估了 MPD 直径诊断 CP 的诊断性能，包括年龄的影响。
纳入 274 例经内镜逆行胰胆管造影（ERCP）证实的 CP 患者和 262 例健康对照者。所有患者均行磁共振胰胆管成像（MRCP），测量胰头部、体部和尾部的 MPD 直径。CP 疾病阶段定义为伴有和不伴有功能（外分泌和/或内分泌）损害的患者。确定了 MPD 直径及其相应截断值诊断 CP 的诊断性能，包括年龄分层分析。
在健康对照组中，MPD 直径受年龄影响，胰头部（P<0.001）、体部（P=0.006）和尾部（P=0.03）。CP 患者的 MPD 直径大于对照组（所有节段 P<0.001）。与无功能胰腺损害的患者相比，有功能胰腺损害的患者胰头部 MPD 直径增大（P=0.03）。MPD 直径诊断 CP 的诊断性能较高（所有节段 ROC-AUC>0.92）。诊断 CP 的最佳 MPD 直径截断值为：<40 岁：2.0（头）和 1.8（体）mm；40-60 岁：2.4（头）和 2.1（体）mm；>60 岁：2.7（头）和 2.1（体）mm。
年龄是评估胰导管系统直径时的一个重要因素。我们的研究结果对现有的定义异常导管直径的阈值提出了挑战，并指出年龄分层评估是未来基于影像学的 CP 诊断和分级系统的一个组成部分。
