Gastrointestinal Imaging

Autoimmune Pancreatitis: Imaging Features

PURPOSE: To retrospectively determine imaging findings in patients with autoimmune pancreatitis.

MATERIALS AND METHODS: Twenty-nine patients (25 male and four female; mean age, 56 years; range, 15–82 years) with histopathologic diagnosis of autoimmune pancreatitis were examined. Data were reviewed by two radiologists in consensus. Imaging findings for review included those from helical computed tomography (CT), 25 patients; magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP), four patients; endoscopic ultrasonography (US), 21 patients; endoscopic retrograde cholangiopancreatography (ERCP), 19 patients; and percutaneous transhepatic cholangiography, one patient. Images were analyzed for appearances of pancreas, biliary and pancreatic ducts, and other findings, such as peripancreatic inflammation, encasement of vessels, mass effect, pancreatic calcification, peripancreatic nodes, and peripancreatic fluid collection. Follow-up images were available in nine patients. Serologic markers such as serum immunoglobulin G (IgG) and antinuclear antibody levels were available in 12 patients.

RESULTS: CT showed diffuse (n = 14) and focal (n = 7) enlargement of pancreas. Seven patients had minimal peripancreatic stranding, with lack of vascular encasement, calcification, or peripancreatic fluid collection. Nine patients had enlarged peripancreatic lymph nodes. MR imaging showed focal (n = 2) and diffuse (n = 2) enlargement with rimlike enhancement in one. MRCP revealed pancreatic duct strictures in two and sclerosing cholangitis–like appearance in one. Endoscopic US showed diffuse enlargement of pancreas with altered echotexture in 13 patients and focal mass in the head in six. ERCP showed stricture of distal common bile duct in 12 patients, irregular narrowing of intrahepatic ducts in six, diffuse irregular narrowing of pancreatic duct in nine, and focal stricture of proximal pancreatic duct in six. Serologic markers showed increased IgG and antinuclear antibody levels in seven of 12 patients. At follow-up, CT abnormalities and common bile duct strictures resolved after steroid therapy in three patients.

CONCLUSION: Features that suggest autoimmune pancreatitis include focal or diffuse pancreatic enlargement, with minimal peripancreatic inflammation and absence of vascular encasement or calcification at CT and endoscopic US, and diffuse irregular narrowing of main pancreatic duct, with associated multiple biliary strictures at ERCP.

© RSNA, 2004


  • 1 Sarner M. Pancreatitis: definitions and classification. In: Go VLW, eds. The exocrine pancreas: biology, pathobiology, and diseases. New York, NY: Raven, 1986; 459-464. Google Scholar
  • 2 Sarles H, Sarles JC, Muratore R, et al. Chronic inflammatory sclerosis of the pancreas: an autonomous pancreatic disease? Am J Dig Dis 1961; 6:688-698. Crossref, MedlineGoogle Scholar
  • 3 Yoshida K, Toki F, Takeuchi T, et al. Chronic pancreatitis caused by an autoimmune abnormality. Proposal of the concept of autoimmune pancreatitis. Dig Dis Sci 1995; 40:1561-1568. Google Scholar
  • 4 Okazaki K, Chiba T. Autoimmune pancreatitis. Gut 2002; 51:1-4. Crossref, MedlineGoogle Scholar
  • 5 Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification and new genetic developments. Gastroenterology 2001; 120:682-707. Crossref, MedlineGoogle Scholar
  • 6 Kazumori H, Ashizawa N, Moriyama N, et al. Primary sclerosing pancreatitis and cholangitis. Int J Pancreatol 1998; 24:123-127. Crossref, MedlineGoogle Scholar
  • 7 Ectors N, Maillet B, Aerts R, et al. Non-alcoholic duct destructive chronic pancreatitis. Gut 1997; 41:263-268. Crossref, MedlineGoogle Scholar
  • 8 Kulling D, Tresch S, Renner E. Triad of sclerosing cholangitis, chronic pancreatitis, and Sjogren’s syndrome: case report and review. Gastrointest Endosc 2003; 57:118-120. Crossref, MedlineGoogle Scholar
  • 9 Akahane C, Takei Y, Horiuchi A, Kawa S, Nishimori I, Ikeda S. A primary Sjogren’s syndrome patient with marked swelling of multiple exocrine glands and sclerosing pancreatitis. Intern Med 2002; 41:749-753. Crossref, MedlineGoogle Scholar
  • 10 Ichimura T, Kondo S, Ambo Y, et al. Primary sclerosing cholangitis associated with autoimmune pancreatitis. Hepatogastroenterology 2002; 49:1221-1224. MedlineGoogle Scholar
  • 11 Saegusa H, Momose M, Kawa S, et al. Hilar and pancreatic gallium-67 accumulation is characteristic feature of autoimmune pancreatitis. Pancreas 2003; 27:20-25. Crossref, MedlineGoogle Scholar
  • 12 Wakabayashi T, Kawaura Y, Satomura Y, et al. Clinical study of chronic pancreatitis with focal irregular narrowing of the main pancreatic duct and mass formation: comparison with chronic pancreatitis showing diffuse irregular narrowing of the main pancreatic duct. Pancreas 2002; 25:283-289. Crossref, MedlineGoogle Scholar
  • 13 Weber SM, Cubukeu-Dimopulo O, Palesty JA, et al. Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma. J Gastrointest Surg 2003; 7:129-137; discussion 137–139. Crossref, MedlineGoogle Scholar
  • 14 Ajisaka H, Fujita H, Kaji M, et al. Lymphoplasmacytic sclerosing pancreatocholangitis successfully treated by pancreatoduodenectomy. J Hepatobiliary Pancreat Surg 2002; 9:522-526. Crossref, MedlineGoogle Scholar
  • 15 Kuroiwa T, Suda T, Takahashi T, et al. Bile duct involvement in a case of autoimmune pancreatitis successfully treated with an oral steroid. Dig Dis Sci 2002; 47:1810-1816. Crossref, MedlineGoogle Scholar
  • 16 Koga Y, Yamaguchi K, Sugitani A, et al. Autoimmune pancreatitis starting as a localized form. J Gastroenterol 2002; 37:133-137. CrossrefGoogle Scholar
  • 17 Fernandez-del Castillo CF, Sahani DV, Lauwers GY. A 36-year-old man with recurrent epigastric pain and elevated amylase levels, case 27–2003. N Engl J Med 2003; 349:893-901. Crossref, MedlineGoogle Scholar
  • 18 Servais A, Pestieau SR, Detry O, et al. Autoimmune pancreatitis mimicking cancer of the head of the pancreas: case report of 2 cases. Acta Gastroenterol Belg 2001; 64:227-230. MedlineGoogle Scholar
  • 19 Irie H, Honda H, Baba S, et al. Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol 1998; 170:1323-1327. Crossref, MedlineGoogle Scholar
  • 20 Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB, Jr. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology 2002; 224:764-768. LinkGoogle Scholar
  • 21 Kamisawa T, Tu Y, Egawa N, et al. Clinicopathologic study on chronic pancreatitis with diffuse irregular narrowing of the main pancreatic duct. Nippon Shokakibyo Gakkai Zasshi 2001; 98:15-24. MedlineGoogle Scholar
  • 22 Kojima E, Kimura K, Noda Y, et al. Autoimmune pancreatitis and multiple bile duct strictures treated effectively with steroid. J Gastroenterol 2003; 38:603-607. Crossref, MedlineGoogle Scholar

Article History

Published in print: Nov 2004