Calcifications, a dilated beaded duct and parenchymal atrophy make the diagnosis; the report adds the complications — pseudocyst, splenic vein thrombosis, pseudoaneurysm, biliary stricture — and whether a mass is hiding in it.
Orient first
- Intraductal and parenchymal calcifications are the most specific CT sign.
- The Cambridge classification grades ductal changes on MRCP (verify the scheme your gastroenterologists use).
- Cancer risk is increased; a focal mass with an abrupt duct cut-off needs work-up.
Acquire the study
- Unenhanced, pancreatic and portal venous phases; thin reformats along the duct.
The manoeuvre
- Unenhanced series: calcifications — parenchymal vs intraductal.
- Main duct calibre in mm and its contour (beaded, irregular); side-branch ectasia.
- Parenchymal thickness and atrophy.
- Complications: pseudocyst, splenic vein thrombosis with gastric varices, pseudoaneurysm (splenic, gastroduodenal) on the arterial phase, distal CBD stricture.
What confirms it
- Pancreatic calcifications with ductal dilatation and irregularity or parenchymal atrophy.
What licenses you to exclude it
- Normal duct and parenchyma on MRCP make established chronic pancreatitis unlikely; early disease may still be only functional.
The classic misread
- Missing a pseudoaneurysm inside a pseudocyst — the arterial phase shows it.