Dilatasi duktus pankreatikus dapat terlihat dengna CT ataupun ulstrasound.

Dilatasi duktus pankreatikus merupakan sekunder akibat karsinoma pankreas. Beberapa laporan juga memperlihatkan bahwa dilatasi duktus pankreatikus dapat juga terjadi pada 60% dari pasien pankreatitis kronis saat dilakukan pemeriksaan Endoscopic Retrograde Cholangiopancreatography (ERCP). Pada pemeriksaan CT-scan, diameter rata-rata dari duktus pankreatikus mayor normalnya 3,3 mm pada kelompok usia 30-50 tahun, dan mencapai 4,6 mm pada usia 70-90 tahun. Dilatasi duktus pada pemeriksaan CT-scan ditandai dengan atenuasi yang lebih rendah dibandingkan dengan parenkim pankreas yang normal, terletak di sentral dan konfigurasinya linear.

Dilatasi duktus pankreatikus tidak memliki spesifisitas terhadap etiologinya. Double Duct sign, merupakan dilatasi dari duktus biliaris komunis dan duktus pankreatikus disebabkan oleh lesi yang menyumbat kedua duktus. Pada pemeriksaan sonography, double duct sign ini dapat disertai adanya batu pada ampula vaterri, maka tanda ini dapat membantu menentukan level dari sumbatan Fishman, A. Isikoff, M. Barkin, J. Significance of a Dilated Pancreatic Duct on CT Examination. 225 full pdf. AJR.133:225-227. August 1979

According to the results of imaging examination (B-US, CT, ERCP) and finding during surgery, pancreatic duct stone can be classified into four different types: Type I: The stones mainly located in the head of pancreas. Endoscopic pancreas drainage and remove of stones is the first line choice of treatment. If it fail the Whipple procedure should be applied. Type II, The stones mainly located in the body of pancreas. It can be treated by Pusetow procedure. Type III, The stones mainly located in the tail of pancreas. The resection of the tail of pancreas or combined with spleenectomy was recommended for the management of this type stones. Type IV, The stones can be found from the head to tail of the main duct of pancreas. The Pusetow-Gillesby procedure or dividing of the neck

of pancreas removing stones from both ends of pancreatic duct and reconstructed by two ends pancreatic duct-ileostomy in Roux-en-Y fashion are the choice of management. 2004 Apr 7;42(7):417-20. PubMed.NCBI [The classification and management of pancreatic duct stone].
Zhonghua Wai Ke Za Zhi. [Article in Chinese] Chen Y, He Y, Zhao J, Liu Y, Liu YF, Cao HL, He H, Gao ZQ, Dou KF. Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.

Normal Pancreatic Duct

Because the pancreatic duct is curved and obliquely oriented, it is usually not seen in its entirety on a single source image; however, the entire length can usually be evaluated when reviewing sequential images. Although an image with thick collimation (23 cm) can demonstrate the duct in its entirety, overlap of ducts may mimic a pseudocyst (10) and volume averaging with adjacent fluid-filled intestine may obscure portions of the duct. Therefore, the multisection, thin-collimation images should be closely scrutinized. When the single-shot fast spin-echo technique is used, the main pancreatic duct in the head, body, and tail can be seen in up to 97%, 97%, and 83% of cases, respectively (1,19). However, because of a decrease in spatial resolution, the pancreatic side branches are seen less frequently, with secondary branches in the head, body, and tail seen in 19%, 10%, and 5% of cases, respectively (19). Because imaging is performed in the physiologic, nondistended state, nonvisualization of the duct at MRCP does not necessarily indicate disease. Secretin (1 clinical unit per kilogram intravenously) can be given to patients suspected of having pancreatic disease; this substance transiently distends the duct (10) and allows better visualization of its morphologic features (10). Maximum dilatation occurs 2 minutes after secretin injection, then the duct relaxes to baseline (10). Persistent dilatation implies papillary stenosis, and dilatation of side branches suggests chronic pancreatitis (10).

Chronic Pancreatitis
Chronic pancreatitis is a chronic inflammatory process of the pancreas, which results in irreversible exocrine dysfunction and irreversible morphologic changes of the pancreas and pancreatic duct. Side-branch ectasia is the most prominent and specific feature of this disease process (Figs 13, 14). Other changes of the main duct and side branches include multifocal dilatations and strictures; an irregular contour; pseudocysts; and filling defects from calculi, mucinous plugs, or debris. Stones as small as 2 mm in diameter can be detected (Fig 14b) (1). Comparisons between MRCP and ERCP in cases of chronic pancreatitis have revealed agreement of 83%100% for identification of ductal dilatation, 70%92% for identification of narrowing, and 92%100% for identification of filling defects (8,36). However, because MRCP is probably not sensitive to the early sidebranch changes of chronic pancreatitis, MRCP should be reserved for diagnosis of

complications or follow-up of more advanced cases. ERCP is more sensitive to early side-branch changes because of its increased spatial resolution.

View larger version: Figure 13. Chronic pancreatitis in a 51-year-old alcoholic man with chronic, episodic abdominal pain. Thick-section single-shot fast spin-echo MRCP image shows ectasia and irregularity of the main pancreatic duct and side branches (arrows), findings compatible with chronic pancreatitis.

View larger version: Figure 14a. Chronic pancreatitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the main pancreatic duct and dilatation of the side branches (open arrows). Note the calculus obstructing the main duct in the pancreatic body (solid arrows). (b) Axial fast spin-echo MR image also shows the calculus (arrows).

View larger version: Figure 14b. Chronic pancreatitis. (a) Single-shot fast spin-echo MRCP image shows multifocal strictures and dilatations of the main pancreatic duct and dilatation of the side branches (open arrows). Note the calculus obstructing the main duct in the pancreatic body (solid arrows). (b) Axial fast spin-echo MR image also shows the calculus (arrows).
Vitellas, K. Keogan, M. Spritzer, C. Nelson,R. MR

Cholangiopancreatography of Bile and Pancreatic Duct Abnormalities with Emphasis on the Single-Shot Fast Spin-Echo Technique. July 2000 RadioGraphics, 20, 939-957
In patients with chronic pancreatitis, dilatation of the pancreatic duct is usually irregular and associated with interspersed strictures, which result from repeated episodes of inflammation [15]. Side branches are almost invariably dilated and parenchymal atrophy is common. Dilatation of the biliary tree is not a usual feature of chronic pancreatitis but seldom may happen when scarring, large stones, or calcifications obstruct both the pancreatic and common bile ducts. Radiological Reasoning: 88-Year-Old Man With Abdominal Pain and Dilated Biliary Tree and Pancreatic Duct Antonio C. Westphalen1 , Fergus V. Coakley, Bonnie N. Joe. AJR:194, June 2010

according to the results of imaging examination (B-US, CT, ERCP) and finding during surgery, pancreatic duct stone can be classified into four different types: Type I: The stones mainly located in the head of pancreas. Endoscopic pancreas drainage and remove of stones is the first line choice of treatment. If it fail the Whipple procedure should be applied. Type II, The stones mainly located in the body of pancreas. It can be treated by Pusetow procedure. Type III, The stones mainly located in the tail of pancreas. The resection of the tail of pancreas or combined with spleenectomy was recommended for the management of this type stones. Type IV, The stones can be found from the head to tail of the main duct of pancreas. The Pusetow-Gillesby procedure or dividing of the neck of pancreas removing stones from both ends of pancreatic duct and reconstructed by two ends pancreatic duct-ileostomy in Roux-en-Y fashion are the choice of management.
Zhonghua Wai Ke Za Zhi. 2004 Apr 7;42(7):417-20.

[The classification and management of pancreatic duct stone]. [Article in Chinese] Chen Y, He Y, Zhao J, Liu Y, Liu YF, Cao HL, He H, Gao ZQ, Dou KF. Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.