Groove pancreatitis: Imaging features and management

Abstract

The aim of this retrospective study was to highlight the imaging findings of groove pancreatitis (GP) as well as its management. Patients and methods: 16 patients diagnosed to have GP were enrolled in this work. The included patients had complete records of the thorough clinical examination and laboratory workup. All patients had been examined by multi-phase contrast enhanced MDCT tailored for pancreatic imaging. Six of these patients were additionally examined by MRI including MRCP., Results: MDCT Multiple detector computed tomography of the 16 patients revealedthe following: (1) a hypodense sheet in the pancreaticoduodenal (PD) groove seen in 12 patients with mild enhancement in the delayed phase seen in 6 of the them; (2) Duodenal wall thickening was seen in 10 patients while (3) associated cysts within the duodenal wall or in PD groove were seen in 6 patients; (4) and pancreatic head enlargement in 8 patients. MRI of Six patients revealedthe following: (1) a T1 hypointense and T2 iso to hyperintense sheet at the PD groove in 4 patients with delayed enhancement in 3 of them; (2) Duodenal wall thickening with T2 high signal was seen in 6 patients while associated cysts within the duodenal wall were seen in 4 patients; (3) Pancreatic head enlargement seen in 4 patients; The MRCP of these patients showed dilated CBD with distal tapering and a distance separating its end from the duodenal wall. Conclusion: GP is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall. Vascular invasion is a sign against diagnosis of GP.

Keywords

• Groove pancreatitis
• Pancreatic cancer
• MRCP