Imaging of inflammatory disease of the pancreas

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

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.

Current trends in acute pancreatitis: Diagnostic and therapeutic challenges

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.

Contrast-enhanced ultrasound combined with serum procalcitonin for evaluating therapeutic efficacy for acute pancreatitis

BACKGROUND

Ultrasound has the advantages of non-invasiveness and simplicity, and plays an important role in the diagnosis and treatment of acute pancreatitis. Contrast-enhanced ultrasound (CEUS) can analyze the pancreatic microcirculation blood perfusion and evaluate its ischemic necrosis status, providing hemodynamic information for clinical diagnosis and treatment.

AIM

To evaluate the clinical value of CEUS with serum procalcitonin (PCT) in evaluating the condition of and the curative effect in acute pancreatitis (AP), as well as its correlation with CT severity index (CTSI).

METHODS

Sixty-three patients with AP treated at our hospital were selected as the research subjects, including 38 patients with mild AP (mild AP group) and 25 with severe AP (severe AP group). Before and after treatment, serum PCT level was measured, pancreatic CEUS and abdominal multi-slice spiral CT were performed, and ultrasound severity index (USSI) and CTSI were recorded. The feasibility of evaluating the curative effect by CEUS combined with PCT was analyzed.

RESULTS

Thirty-seven patients with mild AP and 26 with severe AP were diagnosed by CEUS, which had a sensitivity of 92.00% (23/25), specificity of 92.11% (35/38), and accuracy of 92.06% (58/63). Serum PCT level, USSI, and CTSI in the severe AP group were significantly higher than those in the mild AP group (P < 0.05). There were significant differences in serum PCT level, USSI, and CTSI among different treatment outcome groups (P < 0.05). Serum PCT level and USSI were positively correlated with CTSI after treatment (r = 0.803 and 0.951, respectively; P < 0.05). Serum PCT level and USSI were negatively correlated with clinical efficacy after treatment (r = -0.721 and - 0.836, respectively; P < 0.05).

CONCLUSION

CEUS can effectively display the ischemic necrosis state of pancreatic tissue and accurately reflect the condition of AP. When combined with serum PCT level, CEUS can provide valuable reference for clinical comprehensive and accurate evaluation of the condition and prognosis of AP.