52 year old female with a history of pancreatitis being treated for autoimmune pancreatitis with prednisone. MRI MRCP to evaluate biliary system, and pancreas. ABDOMEN:LIVER, BILIARY TRACT: Incidental note is made of pacreatic divisum. No evidence of intra-or extrahepatic biliary ductal dilation. There is stenosis/narrowing of the distal 2 cm of the common bile duct. No focal mass lesions are identified. No gallstones. No common duct stones are identified. SPLEEN: No significant abnormality noted.PANCREAS: Note is made of pancreatic divisum. There is a normal response to secretin augmentation. There is faint peripheral enhancement along the margins of the pancreas, which is nonspecific, however, correlation with IgG4 levels recommended to exclude the possibility of autoimmune pancreatitis. There is a focus on T1 and T2 prolongation in the uncinate process with associated patchy restricted diffusion and faint enhancement on post contrast images which is suspicious for focal evolving pancreatitis although a focal mass lesion is not entirely excluded. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.There is questionable faint peripheral enhancement along the margins of the pancreas as well as narrowing of the distal common bile duct, which is nonspecific, but can be seen in autoimmune pancreatitis. Correlation with IgG4 levels could be considered if clinically indicated. 2.Focus of enhancing signal abnormality affecting an enlarged uncinate process of the pancreas is nonspecific. While an evolving focal pancreatitis is favored, a follow up examination in 6-12 months is recommended to establish resolution.3.Pancreatic divisum.