Evaluation of Ductus pancreaticus and Ductus choledochus morphometry on magnetic resonance images in patients with acute pancreatitis and its relationship with clinical risk scores

This study aimed to assess the morphometry of the pancreatic duct (PD) and choledochal duct (CD) in individuals experiencing Acute Pancreatitis (AP) and to predict prognosis based on the correlation between clinical risk scoring and diameter changes. We retrospectively analyzed 67 patients treated with a diagnosis of AP between January 2021 and March 2023 at the Gastroenterology Clinic of Tokat Gaziosmanpaşa University Medical Faculty Hospital. These patients underwent MRCP within the indication, and their necessary biochemical parameters were analyzed. Additionally, 65 individuals comprised the healthy control group. In this study, we compared PD and CD morphology, evaluated on MRCP images, with the severity of acute pancreatitis by calculating SIRS, Ranson, BISAP, APACHE II, and Glasgow-Imrie scores. The PD diameter (>3 mm) was larger than normal in 32.8% of the AP group, and the CD diameter (>7 mm) was larger than normal in 38.8%. In the control group, PD and CD diameters were within normal ranges. Mean PD and CD diameters were 2.9±0.8 mm and 7.3±2.9 mm, respectively, in the AP group and 2.2±0.4 mm and 4.3±1.2 mm, respectively, in the control group. No significant difference was found between genders. In the control group, the CD diameter moderately correlated with age (r=0.497, p<0.001). In the AP group, biliary pancreatitis was detected the most (n=40) according to etiology. According to the Revised Atlanta Classification, edematous pancreatitis was found in 61 patients, and necrotizing pancreatitis was found in 6 patients. Regarding severity, 23 patients had mild, 42 had moderate, and 2 had severe pancreatitis. A weak positive correlation between PD diameter and BISAP score (rho=0.250, p=0.041) was observed, but this correlation had low power. No significant correlation was found between PD and CD diameters and other scoring systems. It was concluded that DP and DC diameters were larger in AP patients compared to the control group, and no correlation was observed between the diameters of the ducts and the scoring systems. Therefore, measuring DP and DC diameters alone was not an effective method in the diagnosis and management of AP. Keywords: Acute pancreatitis, Common bile duct, Diameter, MRCP, Pancreas, Pancreatic duct