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Gastrointestinal
Diagnosis
Pancreas
Inflammation
Autoimmune (IgG4) Pancreatitis
Autoimmune (IgG4) Pancreatitis
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Abbreviations

            • Autoimmune pancreatitis (AIP)

          • Synonyms

            • Lymphoplasmacytic sclerosing pancreatitis; primary sclerosing pancreatitis; tumefactive pancreatitis; nonalcoholic destructive pancreatitis

          • Definitions

            • Immune-mediated fibroinflammatory disease primarily involving pancreas responding to steroid therapy

          IMAGING

          • General Features

            • Imaging Recommendations

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Other Modality Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Ha J et al: Meta-analysis of CT and MRI for differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma. Eur Radiol. 31(5):3427-38, 2021
                                            2. Matsubayashi H et al: Comparison of five-phase computed tomography images of type 1 autoimmune pancreatitis and pancreatic cancer: emphasis on cases with atypical images. Pancreatology. 21(3):666-75, 2021
                                            3. Trout AT et al: Current state of imaging of pediatric pancreatitis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. ePub, 2021
                                            4. Zhao Y et al: Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis. Gland Surg. 10(1):347-54, 2021
                                            5. Zhu L et al: DWI of autoimmune pancreatitis: is it an imaging biomarker for disease activity? AJR Am J Roentgenol. 1-7, 2021
                                            6. E L et al: Differentiation of focal-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma using radiomics based on multiphasic computed tomography. J Comput Assist Tomogr. 44(4):511-8, 2020
                                            7. Khandelwal A et al: Autoimmune pancreatitis: an update. Abdom Radiol (NY). 45(5):1359-70, 2020
                                            8. Lopes Vendrami C et al: Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 45(5):1371-86, 2020
                                            9. Löhr JM et al: European guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations. United European Gastroenterol J. 8(6):637-66, 2020
                                            10. Ren H et al: Effective apparent diffusion coefficient parameters for differentiation between mass-forming autoimmune pancreatitis and pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 46(4):1640-7, 2020
                                            11. Schima W et al: Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation. Cancer Imaging. 20(1):52, 2020
                                            12. Takahashi M et al: Diagnostic imaging guide for autoimmune pancreatitis. Jpn J Radiol. 38(7):591-612, 2020
                                            13. Graziani R et al: Autoimmune pancreatitis: multidetector-row computed tomography (MDCT) and magnetic resonance (MR) findings in the Italian experience. Radiol Med. 119(8):558-71, 2014
                                            14. Khandelwal A et al: Recent advances in the diagnosis and management of autoimmune pancreatitis. AJR Am J Roentgenol. 202(5):1007-21, 2014
                                            15. Agrawal S et al: Distinguishing autoimmune pancreatitis from pancreaticobiliary cancers: current strategy. Ann Surg. 255(2):248-58, 2012
                                            16. Alswat K et al: The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice. Am J Gastroenterol. 107(1):56-63, 2012
                                            17. Chandrasekhara V et al: Diagnostic endoscopic retrograde pancreatography for autoimmune pancreatitis: one size does not fit all. Gastroenterology. 142(1):180-2, 2012
                                            18. Hur BY et al: Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: Comparison with pancreatic adenocarcinoma. J Magn Reson Imaging. 36(1):188-97, 2012
                                            19. Muhi A et al: Mass-forming autoimmune pancreatitis and pancreatic carcinoma: differential diagnosis on the basis of computed tomography and magnetic resonance cholangiopancreatography, and diffusion-weighted imaging findings. J Magn Reson Imaging. 35(4):827-36, 2012
                                            20. Nakatani K et al: Utility of FDG PET/CT in IgG4-related systemic disease. Clin Radiol. 67(4):297-305, 2012
                                            21. Sah RP et al: Autoimmune pancreatitis: an update on classification, diagnosis, natural history and management. Curr Gastroenterol Rep. 14(2):95-105, 2012
                                            22. Song TJ et al: Comparison of clinical findings between histologically confirmed type 1 and type 2 autoimmune pancreatitis. J Gastroenterol Hepatol. 27(4):700-8, 2012
                                            23. Sugumar A: Diagnosis and management of autoimmune pancreatitis. Gastroenterol Clin North Am. 41(1):9-22, 2012
                                            24. Takuma K et al: Strategy to differentiate autoimmune pancreatitis from pancreas cancer. World J Gastroenterol. 18(10):1015-20, 2012
                                            25. Zhang L et al: Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas. 40(8):1172-9, 2011
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Autoimmune pancreatitis (AIP)

                                                    • Synonyms

                                                      • Lymphoplasmacytic sclerosing pancreatitis; primary sclerosing pancreatitis; tumefactive pancreatitis; nonalcoholic destructive pancreatitis

                                                    • Definitions

                                                      • Immune-mediated fibroinflammatory disease primarily involving pancreas responding to steroid therapy

                                                    IMAGING

                                                    • General Features

                                                      • Imaging Recommendations

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Other Modality Findings

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Ha J et al: Meta-analysis of CT and MRI for differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma. Eur Radiol. 31(5):3427-38, 2021
                                                                                      2. Matsubayashi H et al: Comparison of five-phase computed tomography images of type 1 autoimmune pancreatitis and pancreatic cancer: emphasis on cases with atypical images. Pancreatology. 21(3):666-75, 2021
                                                                                      3. Trout AT et al: Current state of imaging of pediatric pancreatitis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. ePub, 2021
                                                                                      4. Zhao Y et al: Atypical enhanced computed tomography signs of pancreatic cancer and its differential diagnosis from autoimmune pancreatitis. Gland Surg. 10(1):347-54, 2021
                                                                                      5. Zhu L et al: DWI of autoimmune pancreatitis: is it an imaging biomarker for disease activity? AJR Am J Roentgenol. 1-7, 2021
                                                                                      6. E L et al: Differentiation of focal-type autoimmune pancreatitis from pancreatic ductal adenocarcinoma using radiomics based on multiphasic computed tomography. J Comput Assist Tomogr. 44(4):511-8, 2020
                                                                                      7. Khandelwal A et al: Autoimmune pancreatitis: an update. Abdom Radiol (NY). 45(5):1359-70, 2020
                                                                                      8. Lopes Vendrami C et al: Differentiation of focal autoimmune pancreatitis from pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 45(5):1371-86, 2020
                                                                                      9. Löhr JM et al: European guideline on IgG4-related digestive disease - UEG and SGF evidence-based recommendations. United European Gastroenterol J. 8(6):637-66, 2020
                                                                                      10. Ren H et al: Effective apparent diffusion coefficient parameters for differentiation between mass-forming autoimmune pancreatitis and pancreatic ductal adenocarcinoma. Abdom Radiol (NY). 46(4):1640-7, 2020
                                                                                      11. Schima W et al: Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation. Cancer Imaging. 20(1):52, 2020
                                                                                      12. Takahashi M et al: Diagnostic imaging guide for autoimmune pancreatitis. Jpn J Radiol. 38(7):591-612, 2020
                                                                                      13. Graziani R et al: Autoimmune pancreatitis: multidetector-row computed tomography (MDCT) and magnetic resonance (MR) findings in the Italian experience. Radiol Med. 119(8):558-71, 2014
                                                                                      14. Khandelwal A et al: Recent advances in the diagnosis and management of autoimmune pancreatitis. AJR Am J Roentgenol. 202(5):1007-21, 2014
                                                                                      15. Agrawal S et al: Distinguishing autoimmune pancreatitis from pancreaticobiliary cancers: current strategy. Ann Surg. 255(2):248-58, 2012
                                                                                      16. Alswat K et al: The spectrum of sclerosing cholangitis and the relevance of IgG4 elevations in routine practice. Am J Gastroenterol. 107(1):56-63, 2012
                                                                                      17. Chandrasekhara V et al: Diagnostic endoscopic retrograde pancreatography for autoimmune pancreatitis: one size does not fit all. Gastroenterology. 142(1):180-2, 2012
                                                                                      18. Hur BY et al: Magnetic resonance imaging findings of the mass-forming type of autoimmune pancreatitis: Comparison with pancreatic adenocarcinoma. J Magn Reson Imaging. 36(1):188-97, 2012
                                                                                      19. Muhi A et al: Mass-forming autoimmune pancreatitis and pancreatic carcinoma: differential diagnosis on the basis of computed tomography and magnetic resonance cholangiopancreatography, and diffusion-weighted imaging findings. J Magn Reson Imaging. 35(4):827-36, 2012
                                                                                      20. Nakatani K et al: Utility of FDG PET/CT in IgG4-related systemic disease. Clin Radiol. 67(4):297-305, 2012
                                                                                      21. Sah RP et al: Autoimmune pancreatitis: an update on classification, diagnosis, natural history and management. Curr Gastroenterol Rep. 14(2):95-105, 2012
                                                                                      22. Song TJ et al: Comparison of clinical findings between histologically confirmed type 1 and type 2 autoimmune pancreatitis. J Gastroenterol Hepatol. 27(4):700-8, 2012
                                                                                      23. Sugumar A: Diagnosis and management of autoimmune pancreatitis. Gastroenterol Clin North Am. 41(1):9-22, 2012
                                                                                      24. Takuma K et al: Strategy to differentiate autoimmune pancreatitis from pancreas cancer. World J Gastroenterol. 18(10):1015-20, 2012
                                                                                      25. Zhang L et al: Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas. 40(8):1172-9, 2011