What are the general indications for computed tomography (CT) and magnetic resonance imaging (MRI) of the pancreas?
CT and MRI are commonly used to assess the extent and severity of disease in patients suspected of having pancreatitis, to evaluate for associated complications of pancreatitis, and to provide guidance for percutaneous drainage of peripancreatic fluid collections or percutaneous biopsy of pancreatic lesions. They are also useful to detect and characterize pancreatic lesions in patients at increased risk for pancreatic neoplasms, with symptoms or signs suggestive of pancreatic pathology, or with previously detected incidental pancreatic lesions on other imaging studies. In particular, MRI is often used as a problem-solving tool when an indeterminate pancreatic lesion is detected on other imaging studies, when the patient cannot receive iodinated contrast material for CT examination, or when the patient is pregnant. CT and MRI are also useful for the staging and pretreatment planning of patients with pancreatic malignancy (e.g., to determine the resectability of pancreatic malignancy), for response assessment of tumor following therapy, and for restaging assessment to detect recurrent tumor.
Given its superior soft tissue resolution, MRI is particularly useful for detection of cholelithiasis and choledocholithiasis, assessment of pancreatic duct disruption, identification of pancreaticobiliary developmental abnormalities (e.g., annular pancreas and pancreas divisum), improved assessment of pancreatic and peripancreatic fluid collections, improved detection and characterization of focal cystic or solid pancreatic lesions, particularly when small (<2 cm) in size, and assessment of iron deposition within the pancreas and other organs in the setting of primary (genetic) hemochromatosis.