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von Stade L, Rao S, Marolf AJ. Computed tomographic evaluation of pancreatic perfusion in 10 dogs with acute pancreatitis. Vet Radiol Ultrasound 2023; 64:823-833. [PMID: 37366618 DOI: 10.1111/vru.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/28/2023] Open
Abstract
Severe canine acute pancreatitis can be fatal; imaging features that can predict the clinical course of disease are useful for clinicians. On computed tomography (CT), both pancreatic heterogeneous contrast enhancement and portal vein thrombosis have been correlated with poorer outcome. Perfusion CT is used in human medicine to evaluate pancreatic microcirculation to predict the future development of severe sequela to pancreatitis; this technology has yet to be explored in dogs with acute pancreatitis. The objective of this prospective, case-control study is to evaluate pancreatic perfusion using contrast-enhanced CT in dogs with acute pancreatitis and compare it with previously established values obtained in healthy dogs. Ten client-owned dogs preliminarily diagnosed with acute pancreatitis received a full abdominal ultrasound, specific canine pancreatic lipase (Spec cPL), and perfusion CT. Computer software calculated pancreatic perfusion, peak enhancement index, time to peak enhancement, and blood volume for 3-mm and reformatted 6-mm slices. The data was analyzed using Shapiro-Wilk test, linear mixed model, and Spearman's rho. Values for 3-mm slices were similar to 6-mm slices (all P < 0.05). Dogs with acute pancreatitis had a faster time to peak enhancement than healthy dogs (P = 0.04-0.06). Dogs with acute pancreatitis and homogeneous pancreatic enhancement had higher perfusion, faster time to peak enhancement, and greater blood volume compared to healthy dogs and dogs with acute pancreatitis and heterogeneous pancreatic enhancement (all P = / < 0.05). Pancreatic perfusion decreased with increased pancreatitis severity. No correlation was identified between Spec cPL and pancreatic perfusion (all P > 0.05). These findings preliminarily support perfusion CT in dogs with acute pancreatitis.
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Affiliation(s)
- Lauren von Stade
- Department of Environmental and Radiologic Health Sciences, Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado, USA
| | - Sangeeta Rao
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Angela J Marolf
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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Skornitzke S, Vats N, Mayer P, Kauczor HU, Stiller W. Pancreatic CT perfusion: quantitative meta-analysis of disease discrimination, protocol development, and effect of CT parameters. Insights Imaging 2023; 14:132. [PMID: 37477754 PMCID: PMC10361925 DOI: 10.1186/s13244-023-01471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND This study provides a quantitative meta-analysis of pancreatic CT perfusion studies, investigating choice of study parameters, ability for quantitative discrimination of pancreatic diseases, and influence of acquisition and reconstruction parameters on reported results. METHODS Based on a PubMed search with key terms 'pancreas' or 'pancreatic,' 'dynamic' or 'perfusion,' and 'computed tomography' or 'CT,' 491 articles published between 1982 and 2020 were screened for inclusion in the study. Inclusion criteria were: reported original data, human subjects, five or more datasets, measurements of pancreas or pancreatic pathologies, and reported quantitative perfusion parameters. Study parameters and reported quantitative measurements were extracted, and heterogeneity of study parameters and trends over time are analyzed. Pooled data were tested with weighted ANOVA and ANCOVA models for differences in perfusion results between normal pancreas, pancreatitis, PDAC (pancreatic ductal adenocarcinoma), and non-PDAC (e.g., neuroendocrine tumors, insulinomas) and based on study parameters. RESULTS Reported acquisition parameters were heterogeneous, except for contrast agent amount and injection rate. Tube potential and slice thickness decreased, whereas tube current time product and scan coverage increased over time. Blood flow and blood volume showed significant differences between pathologies (both p < 0.001), unlike permeability (p = 0.11). Study parameters showed a significant effect on reported quantitative measurements (p < 0.05). CONCLUSIONS Significant differences in perfusion measurements between pathologies could be shown for pooled data despite observed heterogeneity in study parameters. Statistical analysis indicates most influential parameters for future optimization and standardization of acquisition protocols. CRITICAL RELEVANCE STATEMENT Quantitative CT perfusion enables differentiation of pancreatic pathologies despite the heterogeneity of study parameters in current clinical practice.
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Affiliation(s)
- Stephan Skornitzke
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Neha Vats
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Philipp Mayer
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Wolfram Stiller
- Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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CUMBO P, CAVALOT G, ROMANO A, ALLASIA M, PALENZONA C, POTENTE F, AZZELLINO M, LO PICCOLO LB. Acute pancreatitis with necrosis of the transverse colon and the great gastric curvature. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tasu JP, Guen RL, Rhouma IB, Guerrab A, Beydoun N, Bergougnoux B, Ingrand P, Herpe G. Accuracy of a CT density threshold enhancement in distinguishing pancreas parenchymal necrosis in cases of acute pancreatitis in the first week. Diagn Interv Imaging 2022; 103:266-272. [PMID: 34991994 DOI: 10.1016/j.diii.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to identify attenuation threshold value on computed tomography (CT) that allowed discriminating between interstitial edematous pancreatitis (IEP) and necrotizing pancreatitis (NP) in patients with acute pancreatitis during the first week of the disease and evaluate interobserver reproducibility for the diagnosis of acute pancreatitis category. MATERIALS AND METHODS Patients with acute pancreatitis who underwent CT examination of the abdomen between March 2015 and December 2019 were retrospectively included. Actual diagnosis of IEP or NP was based on final clinical report, follow-up evaluation, and complications. Six regions of interest were manually placed in the pancreatic gland and peripancreatic fat, and differences in CT attenuation values before contrast injection and during the portal venous phase of enhancement were computed. Performance in the diagnosis of AP category was evaluated using receiver operating characteristic analysis. Interobserver agreement was estimated by the intraclass correlation coefficient (ICC) and Bland Altman analysis was used to estimate reproducibility between pairs of observers. RESULTS Sixty-six patients with NP (46 men, 20 women; mean age, 55 ± 17 [SD] years; age range: 20-89 years) and 70 patients with IEP (39 men, 31 women; mean age, 54 ± 18 [SD] years; age range: 21-87 years) were included. An enhancement value less than 30 Hounsfield units (HU) in the pancreatic gland during the portal phase compared to non-contrast phase, yielded 90.9% sensitivity (60/66; 95% CI: 81.3-96.6), 94.3% specificity (66/70; 95% CI: 86.0-98.4) and an area under curve of 0.958 (95% CI: 0.919-0.996) for the diagnosis of NP versus IEP. Interobserver reproducibility for pancreas enhancement was good using Bland Altman plot and ICC was excellent for pancreatic gland analysis (ICC 0.978; 95% CI: 0.961-0.988) but poor or moderate (ICC ≤0.634) regarding peripancreatic fat necrosis. CONCLUSION By using a pancreas enhancement threshold value of 30 HU, CT is accurate and reproducible for the diagnosis of NP during the first week of the disease.
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Affiliation(s)
- Jean Pierre Tasu
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France; LaTim, UBO and INSERM 1101, University of Brest, 29000 Brest, France.
| | - Raphael Le Guen
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
| | - Inès Ben Rhouma
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
| | - Ayoub Guerrab
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
| | - Nadeem Beydoun
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
| | - Brice Bergougnoux
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
| | - Pierre Ingrand
- CIC 1402, Clinical Investigation center, Bio-statistic and epidemiology, University of Poitiers, 86021 Poitiers, France
| | - Guillaume Herpe
- Department of Diagnostic and Interventional Radiology, University Hospital of Poitiers, 86021 Poitiers, France
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Agostini A, Borgheresi A, Bruno F, Natella R, Floridi C, Carotti M, Giovagnoni A. New advances in CT imaging of pancreas diseases: a narrative review. Gland Surg 2021; 9:2283-2294. [PMID: 33447580 DOI: 10.21037/gs-20-551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the material-selective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.
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Affiliation(s)
- Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Ancona (AN), Italy.,Department of Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona (AN), Italy
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Zheng Z, Ding YX, Qu YX, Cao F, Li F. A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:69. [PMID: 33553362 PMCID: PMC7859757 DOI: 10.21037/atm-20-4802] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory disease that can progress to severe acute pancreatitis (SAP), which increases the risk of death. AP is characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. Other contributing factors may include calcium (Ca2+) overload, mitochondrial dysfunction, impaired autophagy, and endoplasmic reticulum (ER) stress. In addition, exosomes are also associated with pathophysiological processes of many human diseases and may play a biological role in AP. However, the pathogenic mechanism has not been fully elucidated and needs to be further explored to inform treatment. Recently, the treatment guidelines have changed; minimally invasive therapy is advocated more as the core multidisciplinary participation and "step-up" approach. The surgical procedures have gradually changed from open surgery to minimally invasive surgery that primarily includes percutaneous catheter drainage (PCD), endoscopy, small incision surgery, and video-assisted surgery. The current guidelines for the management of AP have been updated and revised in many aspects. The type of fluid to be used, the timing, volume, and speed of administration for fluid resuscitation has been controversial. In addition, the timing and role of nutritional support and prophylactic antibiotic therapy, as well as the timing of the surgical or endoscopic intervention, and the management of complications still have many uncertainties that could negatively impact the prognosis and patients' quality of life. Consequently, to inform clinicians about optimal treatment, we aimed to review recent advances in the understanding of the pathogenesis of AP and its diagnosis and management.
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Affiliation(s)
- Zhi Zheng
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yi-Xuan Ding
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Yuan-Xu Qu
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Feng Cao
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
| | - Fei Li
- Department of General Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Clinical Center for Acute Pancreatitis, Capital Medical University, Beijing, China
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Li C, Ren Q, Wang Z, Wang G. Early prediction of in-hospital mortality in acute pancreatitis: a retrospective observational cohort study based on a large multicentre critical care database. BMJ Open 2020; 10:e041893. [PMID: 33361165 PMCID: PMC7759962 DOI: 10.1136/bmjopen-2020-041893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To develop and validate a prediction model for predicting in-hospital mortality in patients with acute pancreatitis (AP). DESIGN A retrospective observational cohort study based on a large multicentre critical care database. SETTING All subject data were collected from the eICU Collaborative Research Database (eICU-CRD), which covers 200 859 intensive care unit admissions of 139 367 patients in 208 US hospitals between 2014 and 2015. PARTICIPANTS A total of 746 patients with AP were drawn from eICU-CRD. Due to loss to follow-up (four patients) or incomplete data (364 patients), 378 patients were enrolled in the primary cohort to establish a nomogram model and to conduct internal validation. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome of the prediction model was in-hospital mortality. All risk factors found significant in the univariate analysis were considered for multivariate analysis to adjust for confounding factors. Then a nomogram model was established. The performance of the nomogram model was evaluated by the concordance index (C-index) and the calibration plot. The nomogram model was internally validated using the bootstrap resampling method. The predictive accuracy of the nomogram model was compared with that of Acute Physiology, Age, and Chronic Health Evaluation (APACHE) IV. Decision curve analysis (DCA) was performed to evaluate and compare the potential net benefit using of different predictive models. RESULTS The overall in-hospital mortality rate is 4.447%. Age, BUN (blood urea nitrogen) and lactate (ABL) were the independent risk factors determined by multivariate analysis. The C-index of nomogram model ABL (0.896 (95% CI 0.825 to 0.967)) was similar to that of APACHE IV (p=0.086), showing a comparable discriminating power. Calibration plot demonstrated good agreement between the predicted and the actual in-hospital mortality. DCA showed that the nomogram model ABL was clinically useful. CONCLUSIONS Nomogram model ABL, which used readily available data, exhibited high predictive value for predicting in-hospital mortality in AP.
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Affiliation(s)
- Caifeng Li
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Qian Ren
- Advertising Center, Tianjin Daily, Tianjin, China
| | - Zhiqiang Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Guolin Wang
- Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
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Yamamiya A, Kitamura K, Yoshida H, Ishii Y, Mitsui Y, Irisawa A. Prediction of the progression of walled-off necrosis in patients with acute pancreatitis on whole pancreatic perfusion CT. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:739-746. [PMID: 32654346 DOI: 10.1002/jhbp.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/02/2020] [Accepted: 07/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE This study investigated whether measuring pancreatic blood volume (PBV) on whole pancreatic perfusion computed tomography (P-CT) can predict the progression of walled-off necrosis (WON) in patients with acute pancreatitis (AP). METHODS A single-center, retrospective cohort study was conducted between December 2015 and December 2016. The participants were divided into two groups: 14 patients with WON and 15 patients without WON. PBV was measured within 72 hours after the diagnosis of AP, and the final diagnosis of WON was made by contrast-enhanced CT (CE-CT) or endoscopic ultrasonography (EUS) 4 weeks after the onset of AP. RESULTS The minimum CT value did not differ significantly between the two groups. On the other hand, the minimum PBV was significantly lower in the WON group than in the without WON group (1.4 (0.9-9.9) vs 19.8 (8.2-21.7) mL/100 mL, respectively; P = .02). The cutoff value of the minimum PBV for WON was 16.5 mL/100 mL (sensitivity 100%, specificity 67%, AUC 0.85; P = .001). CONCLUSIONS Whole pancreatic P-CT can evaluate pancreatic ischemia visually and quantitatively. The minimum PBV measurement on whole pancreatic P-CT within 72 hours after the diagnosis of AP contributes to the prediction of progression of WON.
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Affiliation(s)
- Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Katsuya Kitamura
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yu Ishii
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Mitsui
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
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Pancreatic perfusion imaging method that reduces radiation dose and maintains image quality by combining volumetric perfusion CT with multiphasic contrast enhanced-CT. Pancreatology 2020; 20:1406-1412. [PMID: 32888809 DOI: 10.1016/j.pan.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/09/2020] [Accepted: 08/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study is to propose and evaluate a new method of volumetric perfusion computed tomography (PCT) incorporated into pancreatic multiphasic contrast enhanced (CE)-CT in the clinical setting. METHODS In this ethically approved study, PCT was incorporated into our existing scanning protocol in 17 patients and effective doses related to PCT were evaluated. CT values and signal-to-noise ratio (SNR) of anatomical structure were compared in diagnostic images that were acquired using 320-detector volumetric scan mode and 64-detector helical scan mode. In addition, focal lesion depiction was qualitatively assessed in the two groups. Perfusion parameters in normal pancreas were measured by two radiologists and the interobserver-reliability was assessed. RESULTS The effective dose of PCT was 5.1 ± 0.3 mSv. The actual effective dose (AED) including the dose used in volumetric scans for diagnostic imaging was 22.8 ± 5.3 mSv and the putative effective dose (PED) was 21.9 ± 9.1 mSv on average. There was no significant difference between AED and PED (p = 0.404). Compared with conventional helical scans, volumetric scans did not decrease CT values or SNR, but rather significantly increased those of the aorta in the arterial phase. Both groups had acceptable qualitatively assessed image quality with no significant difference in the depiction of each structure. There was almost perfect interobserver agreement in the measurement of perfusion parameters (mean ICCs > 0.9). CONCLUSIONS Our scanning protocol for pancreatic perfusion CT provides high-quality images while requiring lower radiation doses than conventional methods.
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Kloer TB, Rao S, Twedt DC, Marolf AJ. Computed tomographic evaluation of pancreatic perfusion in healthy dogs. Am J Vet Res 2020; 81:131-138. [PMID: 31985282 DOI: 10.2460/ajvr.81.2.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility of contrast-enhanced CT for assessment of pancreatic perfusion in healthy dogs. ANIMALS 6 healthy purpose-bred female Treeing Walker Coonhounds. PROCEDURES Contrast-enhanced CT of the cranial part of the abdomen was performed with 3-mm slice thickness. Postprocessing computer software designed for evaluation of human patients was used to calculate perfusion data for the pancreas and liver by use of 3-mm and reformatted 6-mm slices. Differences in perfusion variables between the pancreas and liver and differences in liver-specific data of interest were evaluated with the Friedman test. RESULTS Multiple pancreatic perfusion variables were determined, including perfusion, peak enhancement index, time to peak enhancement, and blood volume. The same variables as well as arterial, portal, and total perfusion and hepatic perfusion index were determined for the liver. Values for 6-mm slices appeared similar to those for 3-mm slices. The liver had significantly greater median perfusion and peak enhancement index, compared with the pancreas. CONCLUSIONS AND CLINICAL RELEVANCE Measurement of pancreatic perfusion with contrast-enhanced CT was feasible in this group of dogs. Hepatic arterial and pancreatic perfusion values were similar to previously published findings for dogs, but hepatic portal and hepatic total perfusion measurements were not. These discrepancies might have been attributable to physiologic differences between dogs and people and related limitations of the CT software intended for evaluation of human patients. Further research is warranted to assess reliability of perfusion variables and applicability of the method for assessment of canine patients with pancreatic abnormalities.
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Abstract
MRI and MRCP play an important role in the diagnosis of chronic pancreatitis (CP) by imaging pancreatic parenchyma and ducts. MRI/MRCP is more widely used than computed tomography (CT) for mild to moderate CP due to its increased sensitivity for pancreatic ductal and gland changes; however, it does not detect the calcifications seen in advanced CP. Quantitative MR imaging offers potential advantages over conventional qualitative imaging, including simplicity of analysis, quantitative and population-based comparisons, and more direct interpretation of detected changes. These techniques may provide quantitative metrics for determining the presence and severity of acinar cell loss and aid in the diagnosis of chronic pancreatitis. Given the fact that the parenchymal changes of CP precede the ductal involvement, there would be a significant benefit from developing MRI/MRCP-based, more robust diagnostic criteria combining ductal and parenchymal findings. Among cross-sectional imaging modalities, multi-detector CT (MDCT) has been a cornerstone for evaluating chronic pancreatitis (CP) since it is ubiquitous, assesses primary disease process, identifies complications like pseudocyst or vascular thrombosis with high sensitivity and specificity, guides therapeutic management decisions, and provides images with isotropic resolution within seconds. Conventional MDCT has certain limitations and is reserved to provide predominantly morphological (e.g., calcifications, organ size) rather than functional information. The emerging applications of radiomics and artificial intelligence are poised to extend the current capabilities of MDCT. In this review article, we will review advanced imaging techniques by MRI, MRCP, CT, and ultrasound.
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Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease? Gastroenterol Res Pract 2019; 2019:6590729. [PMID: 31485219 PMCID: PMC6710743 DOI: 10.1155/2019/6590729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/24/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.
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Jinno N, Hori Y, Naitoh I, Miyabe K, Yoshida M, Natsume M, Kato A, Asano G, Sano H, Hayashi K. Predictive factors for the mortality of acute pancreatitis on admission. PLoS One 2019; 14:e0221468. [PMID: 31437218 PMCID: PMC6706052 DOI: 10.1371/journal.pone.0221468] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023] Open
Abstract
Background and aims The revised Atlanta classification is widely used for the evaluation of acute pancreatitis (AP) severity. However, this classification cannot be used within 48 hours of AP onset. The aim of this study was to investigate the predictive factors of mortality in patients with AP on admission. Methods We evaluated the association between AP mortality and clinical parameters at the time of admission in patients with AP from April 2013 to December 2017 at one university hospital and one tertiary care referral center. Results A total of 203 consecutive patients were enrolled. Nine patients (4.4%) died despite multidisciplinary treatment. In a multivariable analysis, hematocrit ≥ 40% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01–1.13; P = 0.021), blood urea nitrogen (BUN) ≥ 40 mg/dL (OR, 1.26; 95% CI, 1.11–1.42; P < 0.001), base excess < -3.0 mmol/L (OR, 1.15; 95% CI, 1.04–1.26; P = 0.004), and inflammation extending to the rectovesical excavation (OR, 1.19; 95% CI, 1.10–1.30; P < 0.001) on admission were significantly associated with mortality. Conclusion Among the imaging findings, inflammation extending to the rectovesical excavation was the only independent predictive factor for mortality in AP. This simple finding, obtained on computed tomography without contrast agent on admission, might be a promising prognostic factor for AP.
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Affiliation(s)
- Naruomi Jinno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuki Hori
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- * E-mail:
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuyuki Miyabe
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Makoto Natsume
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihisa Kato
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Go Asano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hitoshi Sano
- Department of Gastroenterology, Toyokawa City Hospital, Toyokawa, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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14
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Weight-adapted ultra-low-dose pancreatic perfusion CT: radiation dose, image quality, and perfusion parameters. Abdom Radiol (NY) 2019; 44:2196-2204. [PMID: 30790008 DOI: 10.1007/s00261-019-01938-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We evaluate the reliability and feasibility of weight-adapted ultra-low-dose pancreatic perfusion CT. METHODS A total of 100 (47 men, 53 women) patients were enrolled prospectively and were assigned to five groups (A, B, C, D, and E) with different combination of tube voltage and tube current according to their body weight. Radiation dose parameters including volume CT dose index (CTDI) and dose-length product (DLP) were recorded. Image quality was evaluated both subjectively and objectively (noise, signal-to-noise ratio, contrast-to-noise ratio). Perfusion parameters including blood flow (BF), blood volume (BV), and permeability (PMB) were measured. The dose, image quality measurements, and perfusion parameters were compared between the five groups using one-way analysis of variance (ANOVA). RESULTS Radiation dose reached 8.7 mSv in patients under 50 kg and was 18.9 mSv in patients above 80 kg. The mean subjective image quality score was above 4.45 on a 5-point scale with good agreement between two radiologists. Groups A-D had equivalent performance on objective image quality (P > 0.05), while Group E performed even better (P < 0.05). No significant differences emerged in comparison with perfusion parameters (BF, BV, PMB) of normal pancreas parenchyma between the five groups. CONCLUSION Weight-adapted ultra-low-dose pancreatic perfusion CT can effectively reduce radiation dose without prejudice to image quality, and the perfusion parameters of normal parenchyma are accurate and reliable.
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15
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova J. Functional imaging in pancreatic disease. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Baleato-González S, García-Figueiras R, Luna A, Domínguez-Robla M, Vilanova JC. Functional imaging in pancreatic disease. RADIOLOGIA 2018; 60:451-464. [PMID: 30236460 DOI: 10.1016/j.rx.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
In addition to the classical morphological evaluation of pancreatic disease, the constant technological advances in imaging techniques based fundamentally on computed tomography and magnetic resonance imaging have enabled the quantitative functional and molecular evaluation of this organ. In many cases, this imaging-based information results in substantial changes to patient management and can be a fundamental tool for the development of biomarkers. The aim of this article is to review the role of emerging functional and molecular techniques based on computed tomography and magnetic resonance imaging in the evaluation of pancreatic disease.
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Affiliation(s)
- S Baleato-González
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - R García-Figueiras
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - A Luna
- Grupo Health Time. Director - Advanced Medical Imaging, Sercosa (Servicio de Radiología Computerizada), Clínica Las Nieves, Jaén, España
| | - M Domínguez-Robla
- Departamento de Radiología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - J C Vilanova
- Departamento de Radiología, Clínica Girona-Hospital Santa Caterina, Girona, España
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17
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Reynolds PT, Brady EK, Chawla S. The utility of early cross-sectional imaging to evaluate suspected acute mild pancreatitis. Ann Gastroenterol 2018; 31:628-632. [PMID: 30174401 PMCID: PMC6102458 DOI: 10.20524/aog.2018.0291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background There are roughly 300,000 hospitalizations for acute pancreatitis annually in the United States. Many of the affected patients at our institution undergo computed tomography (CT) or magnetic resonance imaging (MRI) unnecessarily early during their admissions. We hypothesize that cross-sectional imaging within 48 h of admission in patients meeting the criteria for acute, mild pancreatitis is over-utilized and does not change management. Methods We performed a retrospective analysis of patients with a discharge diagnosis of acute pancreatitis from our tertiary care institution from January 1, 2010 to December 31, 2015. Inclusion criteria were a lipase more than three times the upper limit of normal and clinical suspicion of pancreatitis. Exclusion criteria were an etiology of pancreatitis following endoscopic retrograde cholangiopancreatography, recurrent or chronic pancreatitis, severe pancreatitis, and ultrasound findings being the reason for imaging. Results Of the 166 patients who met the criteria for analysis, 105 (63.3%) underwent cross-sectional imaging within 48 h of presentation (CT: 104, MRI: 1). Of the examined CTs, 27 (26.0%) showed no abnormality and 55 (52.9%) revealed uncomplicated pancreatitis. The remaining 22 (21.2%) demonstrated at least one of the following: local complications, biliary ductal dilatation or other findings. On thorough chart review, only two patients received a beneficial change in management as a result of the early imaging. Conclusions This analysis supports current guidelines that early cross-sectional abdominal imaging (CT or MRI) in patients with suspected acute mild pancreatitis does not alter medical management. Early imaging may lead to unnecessary resource use and patient irradiation.
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Affiliation(s)
- Paul T Reynolds
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA.,Grady Memorial Hospital (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA
| | - Evan K Brady
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA.,Grady Memorial Hospital (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA
| | - Saurabh Chawla
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA.,Grady Memorial Hospital (Paul T. Reynolds, Evan K. Brady, Saurabh Chawla), Atlanta, GA, USA
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18
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Smeets XJNM, Litjens G, da Costa DW, Kievit W, van Santvoort HC, Besselink MGH, Fockens P, Bruno MJ, Kolkman JJ, Drenth JPH, Bollen TL, van Geenen EJM. The association between portal system vein diameters and outcomes in acute pancreatitis. Pancreatology 2018; 18:494-499. [PMID: 29784597 DOI: 10.1016/j.pan.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Acute pancreatitis (AP) progresses to necrotizing pancreatitis in 15% of cases. An important pathophysiological mechanism in AP is third spacing of fluids, which leads to intravascular volume depletion. This results in a reduced splanchnic circulation and reduced venous return. Non-visualisation of the portal and splenic vein on early computed tomography (CT) scan, which might be the result of smaller vein diameter due to decreased venous flow, is associated with infected necrosis and mortality in AP. This observation led us to hypothesize that smaller diameters of portal system veins (portal, splenic and superior mesenteric) are associated with increased severity of AP. METHODS We conducted a post-hoc analysis of data from two randomized controlled trials that included patients with predicted severe and mild AP. The primary endpoint was AP-related mortality. The secondary endpoints were (infected) necrotizing pancreatitis and (persistent) organ failure. We performed additional CT measurements of portal system vein diameters and calculated their prognostic value through univariate and multivariate Poisson regression. RESULTS Multivariate regression showed a significant inverse association between splenic vein diameter and mortality (RR 0.75 (0.59-0.97)). Furthermore, there was a significant inverse association between splenic and superior mesenteric vein diameter and (infected) necrosis. Diameters of all veins were inversely associated with organ failure and persistent organ failure. CONCLUSIONS We observed an inverse relationship between portal system vein diameter and morbidity and an inverse relationship between splenic vein diameter and mortality in AP. Further research is needed to test whether these results can be implemented in predictive scoring systems.
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Affiliation(s)
- X J N M Smeets
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - G Litjens
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D W da Costa
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - W Kievit
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H C van Santvoort
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M G H Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J J Kolkman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - E J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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19
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The Accuracy of Pancreatic Perfusion Computed Tomography and Angiography in Predicting Necrotizing Pancreatitis: A Systematic Review. Pancreas 2018; 47:667-674. [PMID: 29894416 DOI: 10.1097/mpa.0000000000001067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Early prediction of necrotizing pancreatitis is important for tailoring treatment, but current scoring systems have moderate accuracy and can be calculated only 24 to 48 hours after disease onset. Evaluation of (micro)circulatory changes in acute pancreatitis at admission by perfusion computed tomography (PCT) or angiography could predict necrosis earlier. Our aim was to systematically review the evidence for angiographic and PCT prediction of necrotizing pancreatitis. We performed a systematic review and searched MEDLINE and Embase. We included cohort studies addressing pancreatic perfusion for prognostication of severity of acute pancreatitis and assessed study quality with a tool specific for diagnostic accuracy studies. Six prospective cohorts with 334 patients were included. Sensitivity of PCT for predicting necrosis ranged from 71% to 100% and specificity from 74% to 100%. The only study directly comparing PCT and angiography found a similar sensitivity (100%) but higher specificity for PCT (90% vs 72%). The included studies had moderate quality. Current studies consistently demonstrate excellent sensitivity and specificity of PCT for early prediction of necrosis. The performance found in our review should be confirmed in larger prospective cohorts as published studies have moderate quality. Furthermore, it should be investigated whether early PCT improves disease course.
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20
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Zhang L, Wang Y, Han J, Shen H, Zhao M, Cai S. Neutrophil-lymphocyte ratio, gamma-glutamyl transpeptidase, lipase, high-density lipoprotein as a panel of factors to predict acute pancreatitis in pregnancy. Medicine (Baltimore) 2018; 97:e11189. [PMID: 29952970 PMCID: PMC6242302 DOI: 10.1097/md.0000000000011189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute pancreatitis in pregnancy (APIP) is a rare but dangerous complication. APIP has common symptoms with acute abdomen. Assessment of an acute abdomen is more complicated during pregnancy because the gravid uterus could mask most of symptomatic signs. It has been a challenge to diagnose APIP by physical examination or diagnostic imaging. Case studies on APIP are also limited for analysis on the risk factors associated with the disease. This retrospective study evaluated a series of risk factors from a relatively substantial number of APIP cases to determine early predictors or prognosis markers for APIP.Fifty-nine APIP patients together with 179 random normal pregnant women in Shengjing Affiliated Hospital of China Medical University were included for this retrospective study. Medical parameters of blood test in biochemistry and hematology were compared between 2 groups using t test. Multivariate logistic regression analysis was performed to investigate the relationship between various factors and APIP using Statistical Applied Software (SAS student version).Compared with normal pregnant women, APIP patients have elevated values in alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen, creatinine, C-reactive protein, direct bilirubin, fibrin degradation products, gamma-glutamyl transpeptidase (GGT), glucose, lipase, pH and decreased values in albumin, fibrinogen, high-density lipoprotein (HDL), hemoglobin, low-density lipoprotein cholesterol (LDL-D), and total proteins from their blood tests. In addition, APIP patients have decreased numbers in red cells but increased numbers in white blood cells and increased ratio of neutrophil/lymphocyte (N/L). Among these factors, N/LR, GGT, lipase, and HDL are significantly associated with APIP. This study suggests that the combination of those factors serve as a panel of indicators for early-onset prognosis of APIP.GGT, lipase, HDL, and N/LR can serve as a panel of factors to predict APIP. More case studies are important to further evaluate the predicting power of this panel factors in APIP.
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Affiliation(s)
- Lichun Zhang
- Department of Emergency, Shengjing Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Yu Wang
- Department of Emergency, Shengjing Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Jun Han
- Department of Emergency, Shengjing Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Haitao Shen
- Department of Emergency, Shengjing Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Min Zhao
- Department of Emergency, Shengjing Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
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21
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Abstract
OBJECTIVE The purpose of this article is to discuss the advances in CT acquisition and image postprocessing as they apply to imaging the pancreas and to conceptualize the role of radiogenomics and machine learning in pancreatic imaging. CONCLUSION CT is the preferred imaging modality for assessment of pancreatic diseases. Recent advances in CT (dual-energy CT, CT perfusion, CT volumetry, and radiogenomics) and emerging computational algorithms (machine learning) have the potential to further increase the value of CT in pancreatic imaging.
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22
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Accuracy of early CT findings for predicting disease course in patients with acute pancreatitis. Jpn J Radiol 2017; 36:151-158. [DOI: 10.1007/s11604-017-0709-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/14/2017] [Indexed: 01/19/2023]
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23
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Tsuji Y, Takahashi N, Isoda H, Koizumi K, Koyasu S, Sekimoto M, Imanaka Y, Yazumi S, Asada M, Nishikawa Y, Yamamoto H, Kikuchi O, Yoshida T, Inokuma T, Katsushima S, Esaka N, Okano A, Kawanami C, Kakiuchi N, Shiokawa M, Kodama Y, Moriyama I, Kajitani T, Kinoshita Y, Chiba T. Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis. J Gastroenterol 2017; 52:1130-1139. [PMID: 28374057 DOI: 10.1007/s00535-017-1330-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF). METHODS We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions. RESULTS Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively. CONCLUSIONS Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .
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Affiliation(s)
- Yoshihisa Tsuji
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. .,Department of Gastroenterology and Hepatology, The Japan Baptist Hospital, 47 Kitashirakawa Yamanomotocho, Sakyo-ku, Kyoto, 606-8273, Japan. .,Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2121, Japan.
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | - Hiroyoshi Isoda
- Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koji Koizumi
- Division of Clinical Radiology Service, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Sho Koyasu
- Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Miho Sekimoto
- Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shujiro Yazumi
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Masanori Asada
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yoshihiro Nishikawa
- Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Hiroshi Yamamoto
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Osamu Kikuchi
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Tsukasa Yoshida
- Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan
| | - Tetsuro Inokuma
- Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, 2-2-1 Minatojima-minami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Shinji Katsushima
- Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Naoki Esaka
- Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Akihiro Okano
- Department of Gastroenterology and Hepatology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Chiharu Kawanami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Nobuyuki Kakiuchi
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Masahiro Shiokawa
- Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Yuzo Kodama
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Ichiro Moriyama
- Division of Clinical Study of Oncology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Takafumi Kajitani
- Department of Radiology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Ma M, Zhai CX, Sun CX. Correlations Between LP-PLA2 Gene Polymorphisms and Susceptibility and Severity of Acute Pancreatitis in a Chinese Population. Genet Test Mol Biomarkers 2017; 21:206-212. [PMID: 28332853 DOI: 10.1089/gtmb.2016.0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Min Ma
- Department of Emergency, Laiwu City People's Hospital, Laiwu, P.R. China
| | - Chun-Xia Zhai
- Department of Emergency, Laiwu City People's Hospital, Laiwu, P.R. China
| | - Cai-Xia Sun
- Department of Gastrointestinal, Colorectal and Anal Surgery, China–Japan Union Hospital of Jilin University, Changchun, P.R. China
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