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Mistakes in Pancreatobiliary Imaging and how to avoid them

Martina Pezzullo, Marianna Arvanitakis

Summary

AI Generated

This article addresses common mistakes in radiological investigation and interpretation of imaging findings in patients with suspected pancreatobiliary diseases, emphasizing the need for collaboration between gastroenterologists and radiologists.

  • Multidetector CT and MRI with MRCP are cross-sectional imaging modalities largely used for patients with pancreatobiliary diseases
  • Correct use and interpretation of radiological findings require good clinical judgment and collaboration between gastroenterologists and radiologists
  • The article highlights frequently made mistakes during radiological investigation and interpretation based on available literature and clinical experience
  • This material would benefit gastroenterologists and radiologists involved in the diagnostic evaluation of pancreatobiliary conditions
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585. [Link]
10.
Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432. [Link]
11.
Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294. [Link]
12.
Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106. [Link]
13.
Lee NJ, Hruban RH and Fishman EK. Pancreatic neuroendocrine tumor: review of heterogeneous spectrum of CT appearance. Abdom Radiol (NY) 2018; 43: 3025–3034. [Link]
14.
Renno A, Hill M, Abdel-Aziz Y, et al. Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2020; 13: 287–297. [Link]
15.
Coquia SF, Kawamoto S, Zaheer A, et al. Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2014; 38: 874–878. [Link]
16.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004; 182: 619–623. [Link]
17.
Prokesch RW, Chow LC, Beaulieu CF, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 2002; 225: 759–765. [Link]
18.
Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73–80. [Link]
19.
Yu J, Turner MA, Fulcher AS, et al. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: Part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187: 1544–1553. [Link]
20.
Crippa S, Arcidiacono PG, De Cobelli F, et al. Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 2020; 8: 249–255. [Link]
21.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524–546. [Link]
22.
Keil R, Kozeluhova J, Dolina J, et al. Acute portal vein thrombosis in noncirrhotic patients - different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis. Scand J Gastroenterol 2019; 54: 1379–1384. [Link]
23.
Junare PR, Udgirkar S, Nair S, et al. Splanchnic venous thrombosis in acute pancreatitis: does anticoagulation affect outcome? Gastroenterology Res 2020; 13: 25–31. [Link]

Abstract

Multidetector computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) are cross-sectional imaging modalities largely used for patients with pancreatobiliary diseases.1–3 Despite recent technological advances, correct use and interpretation of related radiological findings require good clinical judgment and collaboration between gastroenterologists and radiologists. In this article, we highlight mistakes frequently made during the radiological investigation and interpretation of findings in patients with suspected pancreatobiliary diseases, based on the available literature and on our clinical experience.


Topics

Endoscopy Pancreas

Citation

 Arvanitakis M and Pezzullo M. Mistakes in pancreatobiliary imaging and how to avoid them. UEG Education 2020; 20: 12–16.

Published

2020

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UEG Mistakes In Articles
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Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Kymentie Ferdinande, Alberto Zanetto, Virginia Hernández-Gea, Marco Senzolo

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585. [Link]
10.
Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432. [Link]
11.
Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294. [Link]
12.
Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106. [Link]
13.
Lee NJ, Hruban RH and Fishman EK. Pancreatic neuroendocrine tumor: review of heterogeneous spectrum of CT appearance. Abdom Radiol (NY) 2018; 43: 3025–3034. [Link]
14.
Renno A, Hill M, Abdel-Aziz Y, et al. Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2020; 13: 287–297. [Link]
15.
Coquia SF, Kawamoto S, Zaheer A, et al. Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2014; 38: 874–878. [Link]
16.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004; 182: 619–623. [Link]
17.
Prokesch RW, Chow LC, Beaulieu CF, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 2002; 225: 759–765. [Link]
18.
Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73–80. [Link]
19.
Yu J, Turner MA, Fulcher AS, et al. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: Part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187: 1544–1553. [Link]
20.
Crippa S, Arcidiacono PG, De Cobelli F, et al. Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 2020; 8: 249–255. [Link]
21.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524–546. [Link]
22.
Keil R, Kozeluhova J, Dolina J, et al. Acute portal vein thrombosis in noncirrhotic patients - different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis. Scand J Gastroenterol 2019; 54: 1379–1384. [Link]
23.
Junare PR, Udgirkar S, Nair S, et al. Splanchnic venous thrombosis in acute pancreatitis: does anticoagulation affect outcome? Gastroenterology Res 2020; 13: 25–31. [Link]

Abstract

TIPS success is rarely about the procedure alone. It depends on decisions made across the entire clinical pathway.

New in the UEG "Mistakes in…" series: Ferdinande et al., present 10 common mistakes in TIPS for cirrhosis, from referral to long-term follow-up.

Key themes:
• Screen the heart first: cardiac decompensation follows TIPS in up to 20% of patients.
• Refer early: delay costs survival in refractory ascites and high-risk variceal bleeding.
• Prevent encephalopathy by design: careful selection, nutrition, rifaximin, and controlled underdilation.
• Individualise haemodynamic targets and follow up structurally.

Topics

Hepatobiliary Surgery

Published

2026

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Pancreas

Published

2025

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What are the steps for a successful clinical research career? The voyage to Ithaca

Katarzyna Pawlak 1, Enrique de-Madaria 2

Affiliations

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Hospital General Universitario de Alicante, Alicante, Spain

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Education & Training

Published

2021

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UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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Mistakes in enteral stenting and how to avoid them

Jeanin van Hooft, Paul Fockens, Joyce Valerie Veld

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Harrington KA, Shukla-Dave A, Paudyal R, et al. MRI of the pancreas. J Magn Reson Imaging Epub ahead of print April 17, 2020. DOI: 10.1002/jmri.27148. [Link]
2.
Zamboni GA, Ambrosetti MC, Pezzullo M, et al. Optimum imaging of chronic pancreatitis. Abdom Radiol (NY) 2020; 45: 1410–1419. [Link]
3.
Yam BL and Siegelman ES. MR imaging of the biliary system. Radiol Clin North Am 2014; 52: 725–755. [Link]
4.
Brunt LM, Deziel DJ, Telem DA, et al. Safe cholecystectomy multi-society practice guideline and state of the art consensus conference on prevention of bile duct injury during cholecystectomy. Ann Surg 2020; 272: 3–23. [Link]
5.
Rhaiem R, Piardi T, Renard Y, et al. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? J Res Med Sci 2019; 24: 107. [Link]
6.
Katabathina VS, Dasyam AK, Dasyam N, et al. Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics 2014; 34: 565–586. [Link]
7.
Novikov A, Kowalski TE and Loren DE. Practical management of indeterminate biliary strictures. Gastrointest Endosc Clin N Am 2019; 29: 205–214. [Link]
8.
Seo N, Kim SY, Lee SS, et al. Sclerosing cholangitis: clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis. Korean J Radiol 2016; 17: 25–38. [Link]
9.
Kamisawa T, Zen Y, Nakazawa T, et al. Advances in IgG4-related pancreatobiliary diseases. Lancet Gastroenterol Hepatol 2018; 3: 575–585. [Link]
10.
Fernandez YVM and Arvanitakis M. Early diagnosis and management of malignant distal biliary obstruction: a review on current recommendations and guidelines. Clin Exp Gastroenterol 2019; 12: 415–432. [Link]
11.
Vernuccio F, Borhani AA, Dioguardi Burgio M, et al. Common and uncommon pitfalls in pancreatic imaging: it is not always cancer. Abdom Radiol (NY) 2016; 41: 283–294. [Link]
12.
Klauss M, Maier-Hein K, Tjaden C, et al. IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 2016; 26: 2099–2106. [Link]
13.
Lee NJ, Hruban RH and Fishman EK. Pancreatic neuroendocrine tumor: review of heterogeneous spectrum of CT appearance. Abdom Radiol (NY) 2018; 43: 3025–3034. [Link]
14.
Renno A, Hill M, Abdel-Aziz Y, et al. Diagnosis of intrapancreatic accessory spleen by endoscopic ultrasound-guided fine-needle aspiration mimicking a pancreatic neoplasm: a case report and review of literature. Clin J Gastroenterol 2020; 13: 287–297. [Link]
15.
Coquia SF, Kawamoto S, Zaheer A, et al. Intrapancreatic accessory spleen: possibilities of computed tomography in differentiation from nonfunctioning pancreatic neuroendocrine tumor. J Comput Assist Tomogr 2014; 38: 874–878. [Link]
16.
Bronstein YL, Loyer EM, Kaur H, et al. Detection of small pancreatic tumors with multiphasic helical CT. AJR Am J Roentgenol 2004; 182: 619–623. [Link]
17.
Prokesch RW, Chow LC, Beaulieu CF, et al. Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience. Radiology 2002; 225: 759–765. [Link]
18.
Wang W, Shpaner A, Krishna SG, et al. Use of EUS-FNA in diagnosing pancreatic neoplasm without a definitive mass on CT. Gastrointest Endosc 2013; 78: 73–80. [Link]
19.
Yu J, Turner MA, Fulcher AS, et al. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: Part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187: 1544–1553. [Link]
20.
Crippa S, Arcidiacono PG, De Cobelli F, et al. Review of the diagnosis and management of intraductal papillary mucinous neoplasms. United European Gastroenterol J 2020; 8: 249–255. [Link]
21.
Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018; 50: 524–546. [Link]
22.
Keil R, Kozeluhova J, Dolina J, et al. Acute portal vein thrombosis in noncirrhotic patients - different prognoses based on presence of inflammatory markers: a long-term multicenter retrospective analysis. Scand J Gastroenterol 2019; 54: 1379–1384. [Link]
23.
Junare PR, Udgirkar S, Nair S, et al. Splanchnic venous thrombosis in acute pancreatitis: does anticoagulation affect outcome? Gastroenterology Res 2020; 13: 25–31. [Link]

Abstract

Indications include stenosis (oesophageal and colonic) and gastric outlet obstruction

Topics

Radiology & Imaging Surgery

Citation

Veld JV, Fockens P and van Hooft JE. Mistakes in enteral stenting and how to avoid them. UEG Education 2019; 19: 5–8

Published

2019

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Family history of Colorectal cancer- what's next?

Family history of Colorectal cancer- what's next?

Kevin John Monahan Kevin John Monahan, Pradeep Mundre

UEG Podcast Episode
Journal Podcast
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Log In Create a free account

Not sure what you can access? Learn more about account types.

Fluorescence-Guided Endoscopy Targets for Detecting Colorectal Polyps with HGD and T1 Cancer

Ahsen Ustaoglu 1, Nik Dekkers 2, Jurjen J. Boonstra 3

Affiliations

1 Early Cancer Institute, University of Cambridge, United Kingdom

2 Leiden University Medical Center, Netherlands

3 Leids University Medical Center, Oegstgeest, Netherlands

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Topics

Digestive Oncology Endoscopy

Published

2023

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Family history of Colorectal cancer- what's next?

Pradeep Mundre 1, Kevin John Monahan 2

Affiliations

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 West Middlesex Hospital, London, United Kingdom

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Abstract

Topics

Digestive Oncology

Published

2023

More Like This:

Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Marco Senzolo Marco Senzolo, Virginia Hernández-Gea, Alberto Zanetto, Kymentie Ferdinande

Pancreatic cystic neoplasms with Marco del Chiaro

Pancreatic cystic neoplasms with Marco del Chiaro

Egle Dieninyte - Misiune Egle Dieninyte - Misiune, Marco Del Chiaro

What are the steps for a successful clinical research career? The voyage to Ithaca

What are the steps for a successful clinical research career? The voyage to Ithaca

Enrique de-Madaria Enrique de-Madaria, Katarzyna Pawlak

Mistakes in enteral stenting and how to avoid them

Mistakes in enteral stenting and how to avoid them

Jeanin van Hooft Jeanin van Hooft, Paul Fockens, Joyce Valerie Veld

Fluorescence-Guided Endoscopy Targets for Detecting Colorectal Polyps with HGD and T1 Cancer

Fluorescence-Guided Endoscopy Targets for Detecting Colorectal Polyps with HGD and T1 Cancer

Jurjen J. Boonstra Jurjen J. Boonstra, Nik Dekkers, Ahsen Ustaoglu

Family history of Colorectal cancer- what's next?

Family history of Colorectal cancer- what's next?

Kevin John Monahan Kevin John Monahan, Pradeep Mundre

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