Pancreas

MRI of the pancreas

Modern instrumental methods play a huge role in the diagnosis of many diseases. Some of them (radiography or computed tomography) are more informative in the study of the structures of the body, consisting of dense and hard tissues. Others are indispensable for the diagnosis of diseases of internal organs represented by soft tissues. These methods include magnetic resonance imaging (MRI).

The pancreas consists of a parenchyma (own tissue), which produces digestive enzymes and hormones, from small and large excretory channels through which the secret of the body enters the intestine. It is surrounded by a capsule and permeated with blood vessels and nerve plexuses. All these structures are not sufficiently dense and completely transparent when, for example, X-ray examination. Ultrasound scanning can give some idea of ​​the structure of the pancreas, visualizing mainly the boundaries between structures of different tissues. But it is not able to "see" small details or to find out the activity of an organ in dynamics, in real time. And only MRI of the pancreas has become today a truly informative method, in many cases of decisive diagnostic value.


Magnetic tomography helps to differentiate abdominal pain

Advantages of MRI in pancreatic pathologies

Discovered in the middle of the last century, the phenomenon of a pronounced reaction of hydrogen atoms to a magnetic field was soon actively used in medicine. Each tissue of the human body contains hydrogen atoms, which, once in a magnetic field, accelerate their oscillatory motion. With the elimination of the influence of magnetism, their movement returns to normal. It is this difference in the state of hydrogen atoms that became detected by special sensors and formed the basis of magnetic resonance imaging.

The signals from the pancreatic tissue are converted into a visible image in the MRI apparatus, very clear and indicative. Moreover, you can perform several "pictures", which in layers represent the structure of the body. On them it is possible to determine the smallest formations, in diameter from 2 mm, which makes it possible to diagnose the most diverse diseases of the gland in a timely manner.

The method also involves the use of amplification with the help of contrast agents, especially in the study of the cavity structures of an organ. For example, in case of suspected pathology of the excretory ducts or blood vessels. The dynamically performed procedure presents to the diagnostician a series of shots in which it is possible to identify violations not only of the anatomical structure of the pancreas, but also of “failures” in the performance of its functions.

With magnetic resonance tomography, no radiation is applied, and the chemical load, in the form of contrast for particular indications, is very slight and is quickly eliminated by the body. This method is absolutely safe, does not cause any pain to patients and is easily tolerated by them, even during long sessions. It can be carried out repeatedly, if there are certain indications, without the slightest harm to the health of patients and without a negative impact on the state of the pancreas.


The vast majority of patients tolerate the procedure well.

Pathological processes in the body, which violate its structure and functionality, always begin to develop gradually, and often the formation of the clinical picture is somewhat "delayed" in comparison with the existing negative changes in the gland. If the research is carried out at the earliest stages, with the first complaints and initial symptoms, then you can significantly affect the effectiveness of future treatment. Moreover, MRI of the pancreas can also reveal changes in organs located close to it (stomach, duodenum, gall bladder and its ducts, liver).

In general, the main advantages of this modern diagnostic method are the following:

  • a high degree of information content, determination of the size, shape of organs, the state of their external and internal structures;
  • dynamic exploration of functions;
  • the ability to control the development of pathology and timely correction of the treatment scheme;
  • safety, non-invasive, reusable;
  • fast provision of additional and crucial information in cases when data from other methods (ultrasound, radiography) do not help the doctor to make the correct diagnosis.

However, in some situations, even the ability of MRI is not enough. This usually happens if the patient has a comorbid disease that is severe. For example, when pancreatitis develops on the background of gastritis, cholecystitis, hepatitis, or when it is necessary to differentiate a neoplasm in the pancreas. In such cases, additional computed tomography (CT) is used, which provides, together with an MRI, maximum information.


Using the pictures you can calculate the size of the body, determine its shape and structure.

CT also applies to modern techniques that allow rapid differential diagnosis of diseases by obtaining a series of layer-by-layer informative images of organs. But it has special indications, since the basis of the method, as with X-ray diffraction, is the exposure of the patient with X-rays. What is better, MRI or CT, and whether to use them at the same time, decides only the attending doctor, taking into account the individual characteristics of patients.

Indications and Contraindications

Complaints for diseases of the digestive system are often identical. These are nausea, heartburn, vomiting, stool disorders, flatulence (bloating), changes in taste and appetite, and tongue deposits. Pain syndrome, which has certain characteristics, can also indicate possible diseases of two or three internal organs at once. Thus, pain in the upper abdomen can be caused by pathologies of the stomach, duodenum, and pancreas.

Therefore, after completing the examination of the patient and the collection of complaints, the doctor must prescribe additional laboratory and instrumental examination. If you suspect pancreatic disease, the following indications for magnetic tomography are identified:

Tablets for pain in the pancreas
  • a neoplasm in an organ (monitoring the dynamics of its growth, suspicion of the presence of a primary tumor or metastasis);
  • inflammatory or fibrotic changes of the gland in acute or chronic pancreatitis;
  • diseases of the liver, stomach, gallbladder and biliary tract;
  • changes in carbohydrate metabolism (for diabetes mellitus, for example);
  • traumatic injuries of the gland;
  • suspicion of blockage of the ducts of the gland or their hypertension;
  • suspicion of an abscess in the capsule of the gland or in the suborgan tissue;
  • insufficient amount of diagnostic information obtained by other instrumental methods.

In some cases, despite all the advantages of MRI, this study is contraindicated. Sometimes such situations are temporary or relative when they can be corrected in a certain way. For example, in case of mental or neurological pathologies that do not allow purely technical completion of tomography due to the patient’s condition, it is possible to carry out a drug preparation beforehand. During pregnancy, MRI is better not to prescribe, but, if absolutely necessary, this method can be used in the 2nd trimester.


The possibility of an MRI during pregnancy is always determined individually

There are absolute contraindications when MRI has to be replaced by alternative methods. These include a very serious condition of the patient, obesity 3-4 degrees (depending on the capabilities of the tomographic apparatus), the presence of metal implants in the body that can distort the information. It is also important to take into account the possibility of the patient's allergic reactions to contrasting substances if an MRI is planned with contrast. In these cases, you must first exclude the presence of allergies in the patient.

Conducting research

In order for the findings to be as useful as possible for the diagnosis of diseases of the pancreas, it is important to perform certain measures before an MRI scan. Such training is not difficult for the patient and consists of the following appointments:

  • for three days before the procedure, do not take alcohol and drinks with gas;
  • Do not eat food for 5-8 hours before the study;
  • before MRI scan; remove the piercing;
  • if necessary, a cleansing enema is performed.

The procedure is performed in a separate room where an MRI apparatus is installed, usually in the form of a tunnel, in which the patient is placed on a couch. There is ventilation and communication with the doctor. When using contrast (based on gadolinium, not iodine), it is intravenously administered, but after the first scan. Over the next 20-30-40 minutes, depending on the indications, the diagnostician receives a series of images.


Local expansion of the organ indicates the presence of a tumor

Description of pictures usually takes 2-3 hours, during which the doctor determines and ascertains all the slightest changes in the parenchyma, ducts, capsule of the pancreas, as well as in adjacent tissues. The patient receives a conclusion in his hands, which describes the normal parameters of the organ or pathological deviations. It, as a rule, is not the final diagnosis, but helps the attending physician, on the basis of complaints and the clinical picture, to finally decide on the form of the disease of the pancreas.

Deciphering the information obtained in the study

Magnetic resonance imaging allows us to ascertain with great accuracy the morphological changes in the tissues of the organs, characteristic of various pathologies. What MRI of the pancreas shows can only be determined by a trained specialist. Even the smallest changes in the pictures and their various combinations are the most important diagnostic criteria that help to clarify the pathology of the organ in the early stages and often save the patient's life.

Changes in the gland characteristic of the inflammatory process (with pancreatitis) are observed most often. In acute inflammation, a diffuse enlargement of the organ, increased blood supply, looseness and vagueness of the capsule are determined. Often, purulent abscesses form around the gland. For the majority of cases of chronic pancreatitis, on the contrary, the size of the organ is characteristic, due to the replacement of the parenchyma with fibrous tissue. Also observed narrowing and curvature of the ducts, the formation of cysts, fatty degeneration of the parenchyma, the presence of deposits of calcium salts.

If there is a tumor in the pancreas, then an MRI will show this with great certainty, and differentiated: a cyst, pseudocyst, or tumor. Of all detected tumors, almost 90%, unfortunately, are cancer of the organ, adenocarcinoma. The pictures will determine its most frequent localization in the head of the gland, with its increase and change in contours. Layered series will give all the information about the spread of the tumor and its internal structure.


The conclusion of the MRI is the decisive criterion in the formulation of the final diagnosis

Very often, cysts and pseudocystas form in the pancreas. They are visualized as rounded formations, often with several partitions and "pockets", with a thickened capsule. They may extend beyond the organ and have foci of calcification. Unlike purulent abscesses, the shell of cysts and pseudocyst does not have granulation formations, indicating an active inflammatory process.

The value of MRI for the diagnosis of pancreatic pathologies is difficult to overestimate. Using this method, it is possible to detect a malignant tumor, purulent foci and other serious changes in the organ that threaten the health and life of people.

Watch the video: MRI of Liver and Pancreas: When to Have MRCP or ERCP? 9 (December 2019).

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