Morphologic Patterns of Autoimmune Pancreatitis in CT and MRI

Background/Aims: To retrospectively evaluate the morphologic characteristics of autoimmune pancreatitis (AIP) using MRI and CT. Methods: 86 dynamic contrast-enhanced CT and MRI scans in 36 AIP patients were evaluated regarding: different enlargement types, abnormalities of the main pancreatic duct (MPD), morphology of the parenchyma and other associated findings. Results: 3 types of enlargement were found: (1) a focal type (28%), (2) a diffuse type (involving the entire pancreas, 11%) and (3) a combined type (56%). The MPD was usually dilated together with focal or diffuse narrowing in 67% (24/36). Unenhanced MRI showed AIP area in 56% (mostly T1 hypo- and T2 hyperattenuating), and CT in 10% (hypoattenuating). The arterial phase depicted similar patterns for CT and MRI (hypoattenuating in 58 and 52%, respectively). Venous and late venous phase patterns were usually hyperattenuating in MRI (65 and 74%, late enhancement), while CT mostly showed no signal differences (isoattenuating in 57 and 75%), yielding significant differences between CT and MRI for the venous (p ! 0.0001) and the late phase (p = 0.025). Miscellaneous findings were: rim sign (25%), pseudocysts (8%) and infiltration of large vessels (11%). Conclusions: The 'late-enhancement' sign seems to be a key feature and is best detectable with MRI. MRI may be recommended in the diagnostic workup of AIP patients.