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Hu JX, Zhao CF, Wang SL, Tu XY, Huang WB, Chen JN, Xie Y, Chen CR. Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence. World J Gastroenterol 2023; 29:5268-5291. [PMID: 37899784 PMCID: PMC10600804 DOI: 10.3748/wjg.v29.i37.5268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.
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Affiliation(s)
- Jian-Xiong Hu
- Intensive Care Unit, The Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Cheng-Fei Zhao
- School of Pharmacy and Medical Technology, Putian University, Putian 351100, Fujian Province, China
- Key Laboratory of Pharmaceutical Analysis and Laboratory Medicine, Putian University, Putian 351100, Fujian Province, China
| | - Shu-Ling Wang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Xiao-Yan Tu
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Wei-Bin Huang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun-Nian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ying Xie
- School of Mechanical, Electrical and Information Engineering, Putian University, Putian 351100, Fujian Province, China
| | - Cun-Rong Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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Yuan Y, Liao K, Huang Z, Deng L, Tang H, Wang Y, Ye Z, Chen X, Song B, Li Z. Feasibility of using software-aided selection of virtual monoenergetic level for optimal image quality of acute necrotising pancreatitis based on dual-energy computed tomography: a preliminary study. BMC Med Imaging 2023; 23:95. [PMID: 37464338 PMCID: PMC10355045 DOI: 10.1186/s12880-023-01032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/23/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE This study aimed to assess the feasibility of software-aided selection of monoenergetic level for acute necrotising pancreatitis (ANP) depiction compared to other automatic image series generated using dual-energy computed tomography (CT). METHODS The contrast-enhanced dual-source dual-energy CT images in the portal venous phase of 48 patients with ANP were retrospectively analysed. Contrast-to-noise ratio (CNR) of pancreatic parenchyma-to-necrosis, signal-to-noise ratio (SNR) of the pancreas, image noise, and score of subjective diagnosis were measured, calculated, and compared among the CT images of 100 kV, Sn140 kV, weighted-average 120 kV, and optimal single-energy level for CNR. RESULTS CNR of pancreatic parenchyma-to-necrosis in the images of 100 kV, Sn140 kV, weighted-average 120 kV, and the optimal single-energy level for CNR was 5.18 ± 2.39, 3.13 ± 1.35, 5.69 ± 2.35, and 9.99 ± 5.86, respectively; SNR of the pancreas in each group was 6.31 ± 2.77, 4.27 ± 1.56, 7.21 ± 2.69, and 11.83 ± 6.30, respectively; image noise in each group was 18.78 ± 5.20, 17.79 ± 4.63, 13.28 ± 3.13, and 9.31 ± 2.96, respectively; and score of subjective diagnosis in each group was 3.56 ± 0.50, 3.00 ± 0.55, 3.48 ± 0.55, and 3.88 ± 0.33, respectively. The four measurements of the optimal single-energy level for CNR images were significantly different from those of images in the other three groups (P < 0.05). CNR of pancreatic parenchyma-to-necrosis, SNR of the pancreas, and score of subjective diagnosis in the images of the optimal single-energy level for CNR were significantly higher, while the image noise was lower than those in the other three groups (all P = 0.000). CONCLUSION Optimal single-energy level imaging for CNR of dual-source CT could improve quality of CT images in patients with ANP, enhancing the display of necrosis in the pancreas.
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Affiliation(s)
- Yuan Yuan
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Kai Liao
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Liping Deng
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Hehan Tang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China
| | - Xinyue Chen
- CT collaboration, Siemens-healthineers, Chengdu, 610041, Sichuan, P.R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, P.R. China.
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Xu Y, Ye C, Tan B. Evaluation of Inflammatory Infiltration in the Retroperitoneal Space of Acute Pancreatitis Using Computer Tomography and Its Correlation with Clinical Severity. CONTRAST MEDIA & MOLECULAR IMAGING 2023; 2023:7492293. [PMID: 37113247 PMCID: PMC10129425 DOI: 10.1155/2023/7492293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 04/29/2023]
Abstract
This paper investigates the correlation between the degree and severity of CT inflammatory infiltration in the retroperitoneal space of acute pancreatitis (AP). A total of 113 patients were included based on diagnostic criteria. The general data of the patients and the relationship between the computed tomography severity index (CTSI) and pleural effusion (PE), involvement, degree of inflammatory infiltration of retroperitoneal space (RPS), number of peripancreatic effusion sites, and degree of pancreatic necrosis on contrast-enhanced CT at different times were studied. The results showed that the mean age of onset in females was later than that in males; 62 cases involved RPS to varying degrees, with a positive rate of 54.9% (62/113), and the total involvement rates of only the anterior pararenal space (APS); both APS and perirenal space (PS); and APS, PS, and posterior pararenal space (PPS) were 46.9% (53/113), 53.1% (60/113), and 17.7% (20/113), respectively. The degree of inflammatory infiltration in the RPS worsened with the increase in CTSI score; the incidence of PE was higher in the group greater than 48 hours than in the group less than 48 hours; necrosis >50% grade was predominant (43.2%) 5 to 6 days after onset, with a higher detection rate than other time periods (P < 0.05). Thus, when the PPS was involved, the patient's condition can be treated as severe acute pancreatitis (SAP); the higher the degree of inflammatory infiltration in the retroperitoneum, the higher the severity of AP. Enhanced CT examination 5 to 6 days after onset in patients with AP revealed the greatest extent of pancreatic necrosis.
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Affiliation(s)
- YuLong Xu
- Department of Emergency Medicine, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui, China
| | - ChunJuan Ye
- Department of Emergency Medicine, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui, China
| | - Bing Tan
- Department of Emergency Medicine, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui, China
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