Possible pancreatic duct anomalies, their frequency, and association with pancreatitis comparing different radiological methods

Abstract

Introduction: Pancreatic duct anomalies are clinically significant group of conditions that are often identified incidentally during radiological investigations [1]. Although many anomalies remain asymptomatic, conditions, such as pancreas divisum and ansa pancreatica are associated with increased risk of pancreatitis [2,3]. Accurate diagnosis relies heavily on imaging techniques. Aim To investigate the frequency of pancreatic duct anomalies, their association with pancreatitis, and the diagnostic accuracy of various radiological methods. Methods and Materials A systematic review was conducted following PRISMA guidelines, analyzing 18 studies sourced from PubMed database. Keywords included "pancreatic duct anomalies," "pancreatitis," and related terms. Studies released by June 11th, 2024, that met the selection criteria, were retrieved and reviewed. Discussion Systematic review included 18 studies analyzing 5,858 patients, comprising 48% males and 52% females, with an average age ranging from 36.9 to 63.5 years. The most common pancreatic duct anomaly was pancreas divisum (4-10% prevalence in the general population, higher rates among those undergoing imaging for pancreatitis). Studies utilizing MRCP with secretin demonstrated a diagnostic sensitivity of 84.5% and specificity of 88.1% compared to ERCP. While MRCP is less invasive, ERCP was more effective for direct visualization. It was followed by ansa pancreatica (0.5- 1.2% prevalence). This anomaly was predominantly diagnosed using MRCP, with sensitivity and specificity values exceeding 80% when secretin-enhanced sequences were included. A Japanese study with 587 patients revealed a significant association with recurrent acute pancreatitis (11.1% of cases). Lastly, for annular pancreas CT and MRI were effective for visualization. In symptomatic cases, annular pancreas often causes pancreatitis. Imaging studies identified coexisting pancreas divisum in 25% of these cases. MRCP with secretin emerged as the most sensitive and non-invasive imaging modality for detecting pancreatic duct anomalies, offering enhanced ductal visualization. Conclusion MRCP with secretin offers a non-invasive, highly sensitive diagnostic option, while ERCP and EUS remain essential tools for complex or therapeutic cases.