Updates in Pancreatic Trauma Imaging

Traumatic pancreatic injuries are uncommon but are associated with high rates of morbidity and mortality. Early detection is key for patient prognosis and clinical management, specifically as it relates to injuries to the main pancreatic duct (MPD). The 1990 version of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) presumed involvement of the MPD for lacerations spanning greater than 50% of pancreatic parenchymal depth on trauma computed tomography (CT) imaging. However, CT lacks specificity and sensitivity for MPD injuries. As such, the 2024 AAST-OIS revision for pancreatic injuries places increased emphasis on MPD evaluation with more sensitive modalities for duct injury, such as endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. The goal of the 2024 revision is to improve concordance between pancreatic injury grade and patient outcomes, as well as to provide a more accurate description of injury to enhance the quality of future pancreatic trauma research. In this review, we will discuss the new 2024 AAST-OIS updates to pancreatic trauma grading, relevant pancreatic anatomy, incidence, mechanisms, imaging appearance and complications of pancreatic trauma, as well as opportunities for future avenues of study.