Jan 6, 2026DOI: 10.1016/j.jacr.2025.12.014Journal ArticleJACR
Written by: Expert Panel on Gastrointestinal ImagingAyushi GuptaVictoria ChernyakKevin J ChangPriya R BhosaleBrooks D CashKatherine R HallMichael MagnettaJoseph H YacoubKatherine ZukotynskiElena K Korngold
Chronic pancreatitis (CP) is a progressive disorder of the pancreas characterized by irreversible parenchymal and ductal changes, leading to chronic pain and pancreatic insufficiency. Its impact on quality of life can be profound and may further be complicated by acute inflammation superimposed on CP (ACP), potentially accelerating functional decline and increasing morbidity. Imaging plays an important role in diagnosing both CP and ACP, determining severity, identifying underlying causes, and detecting complications. CT is particularly effective at detecting parenchymal calcifications, typically seen in later disease, and for rapid evaluation of ACP. MRI with MRCP is more sensitive for early ductal and parenchymal changes, with secretin-stimulated MRCP further improving detection in mild or early disease. In certain cases, endoscopic ultrasound adds diagnostic value and offers therapeutic intervention. Early and accurate imaging, paired with clinical and laboratory evaluation, is essential for guiding effective patient care in CP. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
VC
Dr. Victoria Chernyak
Radiology · Abdominal ImagingColumbia University Irving Medical Centervictoriac
