Is acute recurrent pancreatitis a chronic disease?

Whether acute recurrent pancreatitis is a chronic disease is still debated and a consensus is not still reached as demonstrated by differences in the classification of acute recurrent pancreatitis. There is major evidence for considering alcoholic pancreatitis as a chronic disease ab initio while chronic pancreatitis lesions detectable in biliary acute recurrent pancreatitis (ARP) seem a casual association. Cystic fibrosis transmembrane con-ductance regulator (CFTR) gene mutation, hereditary and obstructive pancreatitis seem an acute disease that progress to chronic pancreatitis, likely as a consequence of the activation and proliferation of pancreatic stellate cells that produce and activate collagen and therefore fibrosis. From the diagnostic point of view, in patients with acute recurrent pancreatitis Endoscopic ultrasound (EUS) seems the more reliable technique for an accurate evaluation and follow-up of some ductal and parenchymal abnormalities suspected for early chronic pancreatitis.

Dietary Green Tea Extract and Antioxidants Improve Insulin Secretory Functions of Pancreatic β-Cells in Mild and Severe Experimental Rodent Model of Chronic Pancreatitis

Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas. It is predominantly idiopathic (with an unknown cause) in India and mostly due to alcohol in the West. Diabetes that occur secondary to chronic pancreatitis (T3c Diabetes) is often brittle, and is difficult to attain normoglycemia with conventional treatment requiring multiple doses of insulin. Mild and severe model of CP was induced in mice by repeated intraperitoneal injections of cerulein and L-arginine respectively with an intent to study islet dysfunction and develop therapeutic strategy in animal models of CP. Dietary intervention of epigallocatechin-3-gallate (EGCG) was tested in both the models of CP for its beneficial effects on insulin secretory functions. Pancreata collected upon euthanasia were used to study alterations in the morphology of pancreatic parenchyma and inflammation by staining with H&E and fibrotic changes by Masson’s trichrome and picrosirius staining. Insulin secretory functions of islets were evaluated to test the efficacy of the dietary intervention on β-cell functions. Intraperitoneal glucose tolerance test was performed to monitor the glucose homeostasis before and after the dietary intervention. Both the models resulted in CP with dispersed acini, inflammation and fibrosis. The loss of acini and extent of fibrosis was more in L-arginine model. 2-fold improvement in glucose-stimulated insulin secretory functions of islets was observed with 0.5% EGCG dietary intervention in cerulein model of CP and 1.6-fold in L-arginine model of CP. A further improvement in insulin secretion by 3.2-fold was observed with additional dietary supplements like N-acetyl cysteine, curcumin in combination with EGCG. Our results thus demonstrate and highlight the therapeutic potential of dietary green tea (EGCG) supplementation in reversing islet dysfunction and improving glucose homeostasis in experimental chronic pancreatitis in mice.

A Deep Learning Framework for Mass-Forming Chronic Pancreatitis and Pancreatic Ductal Adenocarcinoma Classification Based on Magnetic Resonance Imaging

Pancreatic diseases, including mass-forming chronic pancreatitis (MFCP) and pancreatic ductal adenocarcinoma(PDAC), present with similar imaging features, leading to diagnostic complexities. Deep Learning (DL) methodshave been shown to perform well on diagnostic tasks. Existing DL pancreatic lesion diagnosis studies basedon Magnetic Resonance Imaging (MRI) utilize the prior information to guide models to focus on the lesionregion. However, over-reliance on prior information may ignore the background information that is helpful fordiagnosis. This study verifies the diagnostic significance of the background information using a clinical dataset.Consequently, the Prior Difference Guidance Network (PDGNet) is proposed, merging decoupled lesion andbackground information via the Prior Normalization Fusion (PNF) strategy and the Feature Difference Guidance(FDG) module, to direct the model to concentrate on beneficial regions for diagnosis. Extensive experiments inthe clinical dataset demonstrate that the proposed method achieves promising diagnosis performance: PDGNetsbased on conventional networks record an ACC (Accuracy) and AUC (Area Under the Curve) of 87.50% and89.98%, marking improvements of 8.19% and 7.64% over the prior-free benchmark. Compared to lesion-focusedbenchmarks, the uplift is 6.14% and 6.02%. PDGNets based on advanced networks reach an ACC and AUC of89.77% and 92.80%. The study underscores the potential of harnessing background information in medical imagediagnosis, suggesting a more holistic view for future research.

Pain in chronic pancreatitis:What can we do today?

The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis(CP).In this context,pain represents the most common and debilitating symptom,and it deeply affects patient’s quality of life.Multiple rating scales(unidimensional,bidimensional and multidimensional)have been proposed to quantify CP pain.However,it represents the result of complex mechanisms,involving genetic,neuropathic and neurogenic factors.Considering all these aspects,the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner.First,a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients.The second step,after medical approach,is endoscopic therapy,especially for complicated CP.In case of failure,tailored surgery represents the third step and decompressive or resection procedures can be chosen.In conclusion,CP pain’s management is challenging considering all these complex aspects and the lack of international protocols.

Pain management in chronic pancreatitis

Pain in chronic pancreatitis(CP)is difficult to manage.Many patients suffer from inadequate pain relief,completely incapacitating them in their daily activities.Historically,despite their well-known adverse effects,opioids have been the pillar of treatment regimens in painful CP.The management is now gradually evolving with a better understanding of the underlying pathophysiology of CP-related pain.Clinicians should follow a holistic approach to the management of CPassociated pain,which must involve lifestyle changes that are coupled with analgesic medications and other pain-relieving interventions.Furthermore,there is no easy cure for vanquishing CP-associated pain.Each patient must be evaluated on a case-by-case basis by a multidisciplinary team to decide which treatment option is best suited for that individual.

PRSS1 and SPINK1 mutations in idiopathic chronic and recurrent acute pancreatitis

AIM: To identify gene mutations in PRSS1 and SPINK1 in individuals with early onset idiopathic chronic or recurrent acute pancreatitis.

Risk factors and prediction score for chronic pancreatitis: A nationwide population-based cohort study

AIM To explore the risk factors of developing chronic pan-creatitis （CP） in patients with acute pancreatitis （AP） and develop a prediction score for CP.METHODS Using the National Health Insurance Research Database in Taiwan, we obtained large, population-based data of 5971 eligible patients diagnosed with AP from 2000 to 2013. After excluding patients with obstructive pancreatitis and biliary pancreatitis and those with a follow-up period of less than 1 year, we conducted a multivariate analysis using the data of 3739 patients to identify the risk factors of CP and subsequently develop a scoring system that could predict the development of CP in patients with AP. In addition, we validated the scoring system using a validation cohort.RESULTS Among the study subjects, 142 patients （12.98%） developed CP among patients with RAP. On the other hand, only 32 patients （1.21%） developed CP among patients with only one episode of AP. The multivariate analysis revealed that the presence of recurrent AP （RAP）, alcoho-lism, smoking habit, and age of onset of 〈 55 years were the four important risk factors for CP. We developed a scoring system （risk score 1 and risk score 2） from the derivation cohort by classifying the patients into low-risk, moderate-risk, and high-risk categories based on similar magnitudes of hazard and validated the performance using another validation cohort. Using the prediction score model, the area under the curve （AUC） [95% confdence interval （CI）] in predicting the 5-year CP incidence in risk score 1 （without the number of AP episodes） was 0.83 （0.79, 0.87）, whereas the AUC （95%CI） in risk score 2 （including the number of AP episodes） was 0.84 （0.80, 0.88）. This result demonstrated that the risk score 2 has somewhat better prediction performance than risk score 1. However, both of them had similar performance between the derivation and validation cohorts.CONCLUSIONIn the study,we identifed the risk factors of CP and devel-oped a prediction score model for CP.

Dietary intake in patients with chronic pancreatitis:A systematic review and meta-analysis

BACKGROUND A progressive reduction in the secretion of pancreatic enzymes in patients with chronic pancreatitis(CP)results in malabsorption and ultimate malnutrition.However,the pathogenesis of malnutrition is multifactorial and other factors such as chronic inflammation,alcohol excess and poor dietary intake all contribute.Patients may restrict their dietary intake due to poor appetite or to avoid gastrointestinal symptoms and abdominal pain.Whilst up to half of patients with chronic pancreatitis are reportedly malnourished,the dietary intake of patients with CP is relatively understudied and has not been systematically reviewed to date.AIM To perform a systematic review and meta-analysis of the dietary intakes of patients with CP compared to healthy controls,and to compare the dietary intake of patients with alcohol-related CP and non-alcohol-related CP.METHODS A systematic literature search was performed using EMBASE,MEDLINE,and Cochrane review on studies published between 1946 and August 30th,2019.Adult subjects with a diagnosis of CP who had undergone dietary assessment were included in the systematic review(qualitative analysis).Studies on patients with other pancreatic diseases or who had undergone pancreatic surgery were not included.Studies comparing the dietary intake of patients with CP to that of healthy controls were included in the meta-analysis(quantitative analysis).Metaanalysis was performed using Review Manager 5.3.Newcastle Ottawa Scale(NOS)was used to assess quality of studies.RESULTS Of 6715 studies retrieved in the search,23 were eligible for qualitative analysis while 12 were eligible for quantitative analysis.In the meta-analysis,the total energy(calorie)intake of patients with CP was similar to that of healthy controls[mean difference(MD):171.3;95%confidence interval(CI):-226.01,568.5;P=0.4],however patients with CP consumed significantly fewer non-alcohol calories than controls[MD:-694.1;95%CI:-1256.1,(-132.1);P=0.02].CP patients consumed more protein,but carbohydrate and fat intakes did not differ significantly.Those with alcohol-related CP consumed more mean(standard deviation)calories than CP patients with a non-alcohol aetiology[2642(1090)kcal and 1372(394)kcal,respectively,P=0.046],as well as more protein,fat,but not carbohydrate.CONCLUSION Although patients with CP had similar calorie intake to controls,studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls.A high calorie intake,made up to a large degree by alcohol,may in part contribute to poor nutritional status in CP.

Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance

AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.

Impact of surgery for chronic pancreatitis on the risk of pancreatic cancer:Untying the Gordian knot

Pancreatic ductal adenocarcinoma is an aggressive tumor with poor long-term outcomes.Chronic pancreatitis(CP)is considered a risk factor for the development of pancreatic cancer(PC).Persistent pancreatic inflammation and activation of pancreatic stellate cells play a crucial role in the pathogenesis of CPrelated PC by activating the oncogene pathway.While genetic mutations increase the possibility of recurrent and persistent pancreatic inflammation,they are not directly associated with the development of PC.Recent studies suggest that early surgical intervention for CP might have a protective role in the development of CP-related PC.Hence,the physician faces the clinical question of whether early surgical intervention should be recommended in patients with CP to prevent the development of PC.However,the varying relative risk of PC in different subsets of CP underlines the complex gene-environment interactions in the disease pathogenesis.Hence,it is essential to stratify the risk of PC in each individual patient.This review focuses on the complex relationship between CP and PC and the impact of surgical intervention on PC risk.The proposed risk stratification based on the genetic and environmental factors could guide future research and select patients for prophylactic surgery.

Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis:Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis. METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively, and were then compared to the corresponding histological pancreatic conditions. RESULTS: Pancreatic carcinomas demonstrated type-Ⅲ (n = 13) or Ⅳ (n = 20) TIC. Tumor-forming pancreatitis showed type-Ⅱ (n = 5) or Ⅲ (n = 3) TIC. All islet cell tumors revealed type-Ⅰ. The type-Ⅳ TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

Diagnostic criteria for autoimmune chronic pancreatitis revisited

Autoimmune chronic pancreatitis （AIP） is increasingly being recognized worldwidely, as knowledge of this entity builds up. Above all, AIP is a very attractive disease to clinicians in terms of its dramatic response to the oral steroid therapy in contrast to ordinary chronic pancreatitis. Although many characteristic findings of AIP have been described, definite diagnostic criteria have not been fully established. In the year 2002, the Japan Pancreas Society published the diagnostic criteria of AIP and many clinicians around the world use these criteria for the diagnosis of AIP. The diagnostic criteria proposed by the Japan Pancreas Society, however, are not completely satisfactory and some groups use their own criteria in reporting AIP. This review discusses several potential limitations of current diagnostic criteria for this increasingly recognized condition. The manuscript is organized to emphasize the need for convening a consensus to develop improved diagnostic criteria.

Decreased serum platelet derived growth factor BB levels in acute and increased in chronic pancreatitis

AIM: To examine circulating growth factor concentrations in patients with acute pancreatitis (AP) and chronic pancreatitis (CP), and walled-off pancreatic necrosis (WOPN).

Serum Mac-2 binding protein is a novel biomarker for chronic pancreatitis

AIM: To determine the efficacy of Mac-2 binding protein (Mac-2bp) for diagnosis of chronic pancreatitis.METHODS: Fifty-nine healthy volunteers (HV), 162 patients with chronic pancreatitis (CP), and 94 patients with pancreatic ductal adenocarcinoma (PDAC) were enrolled in this study. We measured serum Mac-2bp using our developed enzyme-linked immunosorbent assay kit. Additional biochemical variables were measured using an automated analyzer (including aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, triglyceride, C-reactive protein, and amylase levels) or chemiluminescent enzyme immunoassay (carbohydrate antigen 19-9 and carcinoembryonic antigen). The ability of Mac-2bp to predict CP diagnosis accurately was assessed using receiver operating characteristic (ROC) analyses.RESULTS: Serum Mac-2bp levels were significantly increased in CP patients compared to HV (P < 0.0001) and PDAC patients (P < 0.0001). Area under the ROC curve values of Mac-2bp for the discrimination of CP from HV and PDAC were 0.727 and 0.784, respectively. Multivariate analyses demonstrated that serum Mac-2bp levels were independent determinants for CP diagnosis from HV and PDAC patients. Immunohistological staining showed that Mac-2bp was expressed faintly in the pancreas tissues of both CP and PDAC patients. Serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, and triglyceride levels were significantly higher in patients with CP or PDAC. Serum Mac-2bp levels were highly correlated with protein levels of alanine aminotransferase, γ-glutamyltransferase, and C-reactive protein, but not amylase, suggesting that the damaged liver produces Mac-2bp.CONCLUSION: Measurement of serum Mac-2bp may be a novel and useful biomarker for CP diagnosis as well as liver fibrosis in the general population.

Does an association exist between chronic pancreatitis and liver cirrhosis in alcoholic subjects?

AIM: To study the possible association between chronic pancreatitis (CP) and liver cirrhosis (LC) of alcoholic etiology,after excluding any other causes.METHODS: One hundred and forty consecutive alcoholic patients were subdivided into three groups: CP (n = 53),LC (n = 57),and asymptomatic alcoholic (n = 30).Clinical,biochemical and morphological characteristics,Child-Pugh index,indocyanine green test,and fecal pancreatic elastase-1 test were assessed.RESULTS: In patients with cirrhosis,major clinical manifestations of CP such as pancreatic pain and steatorrhea,as well as imaging alterations of CP such as calcifications,duct dilation and pseudocysts were absent; insulin-dependent diabetes was present in 5.3% of cases,and elastase-1 test was altered in only 7%,and severely altered in none.In patients with CP,clinical characteristics of cirrhosis such as ascites,encephalopathy and gastrointestinal hemorrhage were present in one case,Child-Pugh grade > A in 5.7%,and altered indocyanine green test in 1.9% cases.In asymptomatic alcoholism,there was only a non-coincident alteration of elastase-1 test and indocyanine test in 14.8% and 10%,respectively,but other characteristics of cirrhosis or CP were absent.An inverse correlation (r = -0.746) between elastase-1 test and indocyanine test was found in alcoholic patients.CONCLUSION: There is a scarce coincidence in clinical and morphological alterations among patients with CP or LC of alcoholic etiology,but an inverse correlation between pancreatic and liver function tests.These findings support that these alcoholic diseases evolve in a different manner and have different etiopathogenesis.

ERCP and CT diagnosis of pancreas divisum and its relation to etiology of chronic pancreatitis

AIM To inquire into the ERCP and CT features of pancreas divisum (PD) and its role in the etiology of chronic pancreatitis. METHODS Fourteen patients with PD were analyzed in regard to the findings in ERCP and CT, the activities of serum amylase and the incidence of pancreatitis. Dorsal ductography via minor papilla cannulation was performed in six of them. RESULTS The length of dorsal and ventral pancreatic duct was 16 56cm±2 52cm and 5 55cm±1 46cm. Most of the patients had dilatation of dorsal (10/14) and ventral (8/14) duct and the stenosis of dorsal duct terminal (10/14). Delayed clearance of contrast in dorsal duct was found in 8 patients. The size and contour of the pancreas were normal in all the patients at conventional CT. Pancreatitis was identified in 13 patients. CONCLUSION Dorsal ductography was necessary in the diagnosis of PD. Conventional CT play little role in the diagnosis of PD. Patients with PD run a higher risk of pancreatitis due to the stenosis of the minor papilla.

Endoscopic ultrasound features of autoimmune pancreatitis: The typical findings and chronic pancreatitis changes

BACKGROUND Few studies have fully described endoscopic ultrasound(EUS)features of newly diagnosed autoimmune pancreatitis(AIP)involving both typical findings and chronic pancreatitis(CP)features.The typical EUS findings are prevalent in the diffuse type AIP but may not be as common for the focal type,and the differences between the diffuse and focal AIP need to be specified.AIM To demonstrate the EUS features of newly diagnosed AIP and the difference between diffuse and focal AIP.METHODS This retrospective single center study included 285 patients of newly diagnosed type 1 AIP following the international consensus diagnostic criteria,with the EUS procedures accomplished before corticosteroid initiation.We explored the EUS features and compared the typical AIP and CP features between the diffuse and focal AIP cases.The Rosemont criteria were employed for CP features definition and CP change level comparison.RESULTS For the typical AIP features,there were significantly more patients in the diffuse group with bile duct wall thickening(158 of 214 cases,73.4%vs 37 of 71 cases,52.1%,P=0.001)and peripancreatic hypoechoic margin(76 of 214 cases,35.5%vs 5 of 71 cases,7.0%,P<0.001).For the CP features,there were significantly more patients in the focal group with main pancreatic duct dilation(30 of 214 cases,14.0%vs 18 of 71 cases,25.3%,P=0.03).The cholangitis-like changes were more prevalent in the focal cases with pancreatic head involvement.The CP change level was relatively limited for newly diagnosed AIP cases in both groups.CONCLUSION This study demonstrated the difference in the typical AIP and CP features between diffuse and focal AIP and indicated the limited CP change level in newly diagnosed AIP.

An experimental study in etiologic effect of pancreas divisum on chronic pancreatitis and its pathogenesis

AIM To investigate the etiologic association of pancreas divisum (PD) with chronic pancreatitis and to clarify its pathogenesis. METHODS A PD canine model was established in 32 dogs. The dogs were randomly divided into 4 groups ( n =8). Group Ⅰ: The communicating branch between the dorsal and ventral pancreatic ducts was partly ligated. Group Ⅱa: The communicating branch was amputated and completely ligated. Group Ⅱb: The dorsal duct was amputated and ligated at 2mm distance to the minor papilla. Group Ⅲ: A sham operation without any amputation or ligation was performed. Before and after operation, the activities of serum phospholipase A2 (PLA2) and amylase (Ams) were assayed and the basal pressures of the ducts were measured when secretin was injected. Pancreatic ductography and the pathologic examination were made. RESULTS The activities of serum PLA2 and Ams in Group Ⅰ,Ⅱa and Ⅱb were significantly increased 5-80 days after operation. At sacrifice, the basal pressures of the ventral duct were significantly higher 30min-60min after provocation in Group Ⅰ, Ⅱa and Ⅱb. The pressures of the dorsal duct were significantly increased in Group Ⅱb but no difference in Group Ⅰ and Ⅱa. Under light microscopy the fibrosis of interlobus and periducts, the destruction of acini and infiltration of inflammatory cell in dorsal and ventral pancreas were found in Group Ⅱb. But in Group Ⅰ and Ⅱa, these findings were present only in ventral pancreas. The electron microscopy showed that in ventral pancreas of Groups Ⅰ and Ⅱa and the dorsal and ventral pancreas of Group Ⅱb, the rough endoplasmic reticulum of the acinar cells showed granules scaling, fusion and dilatation. The zymogen granules decreased and the mitochondria was swollen. CONCLUSION PD is one of etiologic factors in chronic pancreatitis. The pathogenesis is the functional obstruction of the minor papilla at the peak stage of secretion.

Changing trends in the minimally invasive surgery for chronic pancreatitis

Chronic pancreatitis is a debilitating pancreatic inflammatory disease characterized by intractable pain resulting in poor quality of life.Conventional management of pancreatic pain consists of a step-up approach with medications and lifestyle modifications followed by endoscopic intervention.Traditionally surgery is reserved for patients who do not improve with other interventions.However,recent studies suggest that early surgical intervention is more beneficial as it can mitigate the progression of the pathological process and prevent loss of pancreatic function.Despite the widespread adoption of minimally invasive approaches in various gastrointestinal surgical disorders,minimally invasive surgery for chronic pancreatitis is slow to evolve.Technical difficulty due to severe inflammatory changes has been the major impediment to the widespread usage of minimally invasive surgery in chronic pancreatitis.With this background,the present review aimed to critically analyze the available evidence on the minimally invasive treatment of chronic pancreatitis.A Pub Med search of all relevant articles was performed using the appropriate keywords,parentheses,and Boolean operators.Most initial laparoscopic series have reported the feasibility of lateral pancreaticojejunostomy,considered an adequate procedure only in a small proportion of patients.The pancreatic head is the pacemaker of pain,so adequate decompression is critical for long-term pain relief.Recent studies have documented the feasibility of minimally invasive duodenum-preserving pancreatic head resection.With improvements in laparoscopic instrumentation and technological advances,minimally invasive surgery for chronic pancreatitis is gaining momentum.However,more high-quality evidence is required to document the superiority of minimally invasive surgery for chronic pancreatitis.

Pancreatic Head Carcinoma Versus Chronic Pancreatitis of Pancreatic Head: MR Imaging

Objective: To evaluate the manifestation of pancreatic head carcinoma andchronic pancreatitis of pancreatic head on magnetic resonance (MR) imaging and to determine whetherMR imaging can distinguish the two diseases. Methods: A retrospective review of MR findings wasperformed for 24 patients with pancreatic head carcinoma and 3 patients with chronic pancreatitis ofpancreatic head. SE T1WI and FSE T2WI sequences with and without fat suppression were performed onall 27 cases. Enhanced SE T1WI with fat suppression was performed on 8 patients with carcinomas and3 patients with pancreatitis, respectively. When dilatation of the pancreatic and/or biliary ductswas noted on T2WI sequence, MRCP were performed on 23 patients with carcinoma and 1 patient withpancreatitis, respectively. Results: Cases of carcinoma presented hypointensity (n=8) or mildhypointensity (n=16) on conventional SE T1WI, hy-perintensity (n=8), mild hyperintensity (n=5),isointensity (n=10) or hypointensity (n=1) on conventional FSE T2WI,hyperintensity (n=11),isointensity (n=11) or mild hypointensity (n=2) on FSE T2WI with fat suppression, and hypointensity(n=24) on fat-suppressed SE T1WI. MRCP demonstrated typical 'double duct sign' and abruptinterruption at distal segment of dilated common bile duct. All 8 patients with carcinoma showedlittle enhancement. All 3 patients with chronic pancreatitis showed mild hypointensity oriosintensity on conventional SE T1WI and hyperintensity on conventional FSE T2WI sequences,respectively. Two patients showed isointensity and mild hyperintensity on fat-suppressed SE T1WI andFSE T2WI sequences, respectively. The remaining patient showed hypointensity and heterogeneousintensity on fat-suppressed SE T1WI and FSE T2WI sequences respectively and a mild dilated commonbiliary duct with irregularly dilated proximal pancreatic duct on MRCP. All 3 patients with chronicpancreatitis showed various enhancements. Conclusion: Both pancreatic head carcinoma and chronicpancreatitis show various signals on various sequences and abnormal pancreatic enhancement patternand most cases of pancreatic head carcinoma and some cases of chronic pancreatitis show abnormalMRCP appearances. With the combined use of multiple sequences, especially precontrast andpostcontrast SE T1WI FS and MRCP, pancreatic head carcinoma and chronic pancreatitis of pancreatichead may be distinguished from each other.