 Hello everyone, myself, Dr. Aman Shragupta, JR2 radiology department from Dr. VPMC Nasheed. Today I'll be presenting a paper on spectrum of findings in MRCP and evaluation of chronic pancreatitis case series. So that is a brief about the abstract chronic pancreatitis is characterized by relentless inflammatory and fibrotic changes of the gland eventually leading to exocrine and endocrine dysfunction. It can severely impair the quality of life besides stress, threatening acute and long-term complications. And the current incidence ranges from 4.4 to 14% per 1 lakh people with a prevalence of 36.9 to 52.4 per 1 lakh persons with a male predominance by a factor of 1.5 to 4.6 and a maiden survival of 20 years. So aim is to study the role of MRI or MRCP in evaluating the spectrum of chronic pancreatitis. Materials, methods of MRI brain was done in 50 patients with clinical suspicion of chronic pancreatitis and MRI combined with MRCP is an excellent modality to assess patients with clinically suspected chronic pancreatitis. And results were obtained which was MRI is useful in determining different spectrum of findings of chronic pancreatitis and it's associated complications. So pancreas is an accessory organ of digestion known to have dual function in the endocrine and exocrine systems. And the pancreas has a main pancreatic duct running through the length of it and accessory duct and various cell types. The ducts can become blocked or they can be genetically deformed. During constant inflammation scarring and fibrosis of the ducts leads to hormone and damage to many structures impairing its secretory functions. Chronic pancreatitis is a progressive inflammatory disease of the pancreas that affects both functions that is exocrine and as well as endocrinitis function of the pancreas that is clinical entity that results from the cumulative injury sustained by the pancreas over time. Chronic pancreatitis is an important gastrointestinal cause of morbidity worldwide and early diagnosis of chronic pancreatitis is crucial to the human cause of the disease. However, majority of the cases are diagnosed in the advanced stage. So the role of the various imaging techniques is the diagnosis of the chronic pancreatitis is important for the early intervention. Early diagnosis of the chronic pancreatitis is difficult. Biochemical studies do not help in definite diagnosis in the early stages. Definitive diagnosis of chronic pancreatitis is established in advanced cases with a destruction of greater than 90% of the pancreas. Several imaging modalities have been used to assess the pancreas such as abdominal radiographs, ultrasound, computed tomography, MRCP and ERCP. So radiograph is now an absolute tool for the diagnosis of chronic pancreatitis and has a poor sensitivity. Ultrasonography of pancreas is challenging due to the boggle gases, shadows, obscuring part or whole of the pancreas. Trans-abdominal sonography is a limited scope in assessment of the pancreas in the obeys individuals and gashes of the abhorment as a sensitivity and specificity of 83% and 80% respectively for the diagnosis of chronic pancreatitis. So drawbacks of the endoscopic ultrasound are its enter and intra-observer variability and false positivity. As a few findings of chronic pancreatitis like echogenic septations can be normally seen with aging in smokers and in alcoholics. Calcifications are seen in the late stages of chronic pancreatitis and hence detection of chronic pancreatitis in early stages using CT is difficult. Sensitivity of CTs in detecting late stages of chronic pancreatitis is 60-95%. MRI and MRCP has superseded the CT in detection of pancreatic ductile abnormalities and as MRCP is a noninvasive tool it has preferred for ERCP for the diagnostic imaging of the bile duct and pancreatic ducts. MRCP or MRI is more sensitive than CT and is emerging as the initial radiological investigation of choice for the evaluation of chronic pancreatitis and unequivocal CT scans. Ames and objectives to emphasize on the role of the MRI or MRCP detection and characterization of chronic pancreatitis and to study the different imaging patterns of chronic pancreatitis using MRI and MRCP. So, etiopathogenesis will shortly look into it causes of chronic pancreatitis includes alcohol abuse, ductile obstruction, genetics, chemotherapy, auto human diseases such as SLE and auto human pancreatitis. New studies are finding that deficiencies in certain vitamins and antioxidants as well may be linked to the disease. So, the most common cause is alcohol consumption, the alcohol increase secretions of proteins from as in our cells causing the fluid to become viscous leading to ductile obstruction as in fibrosis and atrophy. Fortunately, less than 10% of alcoholics developed this. So, in chronic pancreatitis suggesting that the other mechanism play a role in the pathology other common causes include hypercalcemia, hyperlipidemia, nutrition obstruction with that medication. So, there is a diguaro that mnemonic for causes of chronic pancreatitis is toxic metabolite, adiopathic, genetic, autoimmune, recurrent and severe acupunctitis and obstructive. Cause of illness is the early phase is approximately first five years of the illness middle phase is first five to 10 years and late phase is for approximately 10 years of onwards. So, the role of MR imaging is the MRCP is the premier diagnostic imaging study because it can reveal calcifications that is a hallmark sign and chronic enlargement atrophy or ductile obstruction or dilatation MRCP has high sensitivity and specificity for chronic chronic pancreatitis. Then there's the trans abdominal ultrasound or brain cells, though both can reveal calcifications, but MRI is more sensitive than CT and is emerging as the initial radiological imaging modality of choice for the evaluation of chronic pancreatitis with equivocal CT scans. Features of chronic pancreatitis can be divided into early or late findings early low signal intensity pancreas on T1 weighted fat suppressed images decreased and delayed enhancement after IV contrast administration of dilated side branches. Here we can see the low signal intensity pancreas on T1 weighted fat suppressed images. Whereas in late findings are a parankimal atrophy or enlargement subsist formation, dilatation and beating of the pancreatic duct often with intraductal calcification could give a chain of lake appearance. Here we can see the beaded pancreatic duct with a chain with a chain of lake appearance and the subsist formation in the same patient. On conventional MRI, normal pancreas appears diffuse the upper intense on T1 weighted images due to presence of proteinaceous enzyme. Fat saturated sequence helps in suppressing the retroperitoneal fat and thus improves the contrast between the hyper intense pancreas and the fat suppressed retroperitoneum. So on T1 we'll see a hyper intense areas corresponding to inflammation fibrosis of vocal lesions. In late findings contrasting on T1 will show heterogeneous signals and delayed post-cadolinium enhancement due to presence of fibrotic areas which impede the capillary flow and reduced antroposterior thickness of the pancreas that will lead to an atrophy and then calcifications and ductal calculate and MRCP is the most useful for ductal assessment. Spectrum of injury is the grading for chronic pancreatitis was done based on Cambridge calcification, based on the status of the main pancreatic duct and the presence of the side branches abnormalities. So grading was like, one classification is for the normal pancreas, Cambridge II is equivocal that is dilatation or obstruction of less than three side branches with a normal main pancreatic duct. Cambridge III that is mild grade is dilatation and obstruction of more than three side branches with normal main pancreatic duct. Cambridge IV is moderate is Cambridge III with stenosis and dilatation of main pancreatic duct and Cambridge V is severe. Cambridge III and IV plus additional obstructions is stenosis, pancreatic duct and calculate. So in our case series, we found one normal case equivocal seven cases mild 10 cases moderate 20 cases and severe 12 cases. So moderate pancreatitis was the most common finding in our case series moderate pancreatitis was seen as 40% cases, whereas severe pancreatitis and 24% of the cases. So basic types of chronic pancreatitis are chronic obstructive chronic calcifying autoimmune pancreatitis, tropical pancreatitis and tooth pancreatitis. So morphological and etiological classification. We on our case series we divided the number of cases so we 32 number of cases we got from chronic chronic calcified pancreatitis chronic obstructive pancreatitis were 12 of them autoimmune were four of them and tooth pancreatitis was one and tropical one. Chronic calcifying pancreatitis is a case with a tiny T1 hypo intense areas in a 16 year old man with small pancreatic duct stone causing duct obstruction and supplemental pancreatitis. Exiled T1 fat weighted fat suppressed image shows abnormal low signal intensity of pancreatic tail while remainder of the pancreatitis has normal bright signal intensity. In a chronic obstructive pancreatitis, we saw a dilated pancreatic duct with a obstructing pancreatic stone in a 24 year old woman with small pancreatic duct stone causing duct obstruction and pancreatitis. Exiled enhanced even weighted fat suppressed image obtained during arterial phase shows delayed enhancement of pancreatic tail related to normal pancreatitis to fibrosis. So this is another case of autoimmune pancreatitis and which can see a sausage shaped pancreas and 24 year old male shows decreased signal intensity on T1 weighted images on T1 gadolinium images. You can see delayed paranthamyl enhancement on dynamic scanning and DWI and ADC we can see restriction with high DWI signal and low ADC signal. On MRCP multiple intraepatic duct structures and common biliary and diffuse narung of main pancreatic duct can be seen. So another form of chronic pancreatitis is groove pancreatitis is another case we saw that was 57 year old male with two history of chronic pancreatitis and a groove pancreatitis in which the paradoid in a groove involvement was there with a bulky head of pancreas. Complications of chronic pancreatitis was seen involving pancreas itself and tissue surrounding the pancreas. Most common pancreatic complication was pseudosys formation in 54% of the patients most common extra pancreatic complications were including the portal vein or splenic enthrombosis with or without resultant splenic or liver infarcts less frequent were internal pancreatic fistula obstructions of different parts of gastrointestinal tract of the 50 subjects 24 of them developed complications. So these were the findings we got pseudosys in 13 patients world of necrosis in two patients and extract pancreatic complications in with vascular complications in four of them biliary complications in three of them pancreatic carcinoma in one of them. So this is a case of pancreatic pseudosys with incidental finding of gallstones with recurrent pancreatitis exality toward the image shows thick walled loculated cystic lesion located primarily in the Lisses Act representing pseudosys and the same patient in another patient in 59 year old woman man with history of chronic pancreatitis. We saw a ductile so common blood biodect dilatation with a stone evaluating the biliary tract coronal images shows the dilatation of common blood duct and contains the calculus. Common blood duct dilatation was again seen in one patient with history of chronic pancreatitis T2 weighted rare images shows dilated common biodect with funnel shaped narrowing. So our conclusion is diagnosis of chronic pancreatitis continues to present a clinical challenge. However, recent guidelines have brought much needed direction and clarity to this endeavor. This review we emphasize the role of MRI in imaging all types of chronic pancreatitis and complications as well MRI is a valuable alternative modality with at least equal diagnostic performance to CT for the diagnosis and follow up of chronic pancreatitis. Additive advantages of MRCP imaging protocols make MRI a very accurate investigation modality for assessing patients with pancreatitis particularly acutely ill patients unable to breath hold. So MRCP is equally or equally or more important than CT and thank you. These are my references.