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Alius C, Serban D, Tribus LC, Costea DO, Cristea BM, Serboiu C, Motofei I, Dascalu AM, Velescu B, Tudor C, Socea B, Bobirca A, Vancea G, Tanasescu D, Bratu DG. When Not to Operate on Acute Cases-A Surgeon's Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography. J Imaging 2023; 9:200. [PMID: 37888307 PMCID: PMC10607302 DOI: 10.3390/jimaging9100200] [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: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical problem solving evolves in parallel with advances in technology and discoveries in the medical field. However, it always reverts to basic cognitive processes involved in critical thinking, such as hypothetical-deductive reasoning, pattern recognition, and compilation models. When dealing with cases of acute abdominal pain, clinicians should employ all available tools that allow them to rapidly refine their analysis for a definitive diagnosis. Therefore, we propose a standardized method for the quick assessment of abdominopelvic computed tomography as a supplement to the traditional clinical reasoning process. This narrative review explores the cognitive basis of errors in reading imaging. It explains the practical use of attenuation values, contrast phases, and windowing for non-radiologists and details a multistep protocol for finding radiological cues during CT reading and interpretation. This systematic approach describes the salient features and technical tools needed to ascertain the causality between clinical patterns and abdominopelvic changes visible on CT scans from a surgeon's perspective. It comprises 16 sections that should be read successively and that cover the entire abdominopelvic region. Each section details specific radiological signs and provides clear explanations for targeted searches, as well as anatomical and technical hints. Reliance on imaging in clinical problem solving does not make a decision dichotomous nor does it guarantee success in diagnostic endeavors. However, it contributes exact information for supporting the clinical assessments even in the most subtle and intricate conditions.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Bruno Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Anca Bobirca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
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Baroud S, Chandrasekhara V, Storm AC, Law RJ, Vargas EJ, Levy MJ, Mahmoud T, Bazerbachi F, Bofill-Garcia A, Ghazi R, Maselli DB, Martin JA, Vege SS, Takahashi N, Petersen BT, Topazian MD, Abu Dayyeh BK. Novel classification system for walled-off necrosis: a step toward standardized nomenclature and risk-stratification framework. Gastrointest Endosc 2023; 97:300-308. [PMID: 36208794 DOI: 10.1016/j.gie.2022.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The optimal therapeutic approach for walled-off necrosis (WON) is not fully understood, given the lack of a validated classification system. We propose a novel and robust classification system based on radiologic and clinical factors to standardize the nomenclature, provide a framework to guide comparative effectiveness trials, and inform the optimal WON interventional approach. METHODS This was a retrospective analysis of patients who underwent endoscopic management of WON by lumen-apposing metal stent placement at a tertiary referral center. Patients were classified according to the proposed QNI classification system: quadrant ("Q"), represented an abdominal quadrant distribution; necrosis ("N"), denoted by the percentage of necrosis of WON; and infection ("I"), denoted as positive blood culture and/or systemic inflammatory response syndrome reaction with a positive WON culture. Two blinded reviewers classified all patients according to the QNI system. Patients were then divided into 2 groups: those with a lower QNI stratification (≤2 quadrants and ≤30% necrosis; group 1) and those with a higher stratification (≥3 quadrants, 2 quadrants with ≥30% necrosis, or 1 quadrant with >60% necrosis and infection; group 2). The primary outcome was mean time to WON resolution. Secondary procedural and clinical outcomes between the groups were compared. RESULTS Seventy-one patients (75% men) were included and stratified by the QNI classification; group 1 comprised 17 patients and group 2, 54 patients. Patients in group 2 had a higher number of necrosectomies, longer hospital stays, and more readmissions. The mean time to resolution was longer in group 2 than in group 1 (79.6 ± 7.76 days vs 48.4 ± 9.22 days, P = .02). The mortality rate was higher in group 2 (15% vs 0%, P = .18). CONCLUSIONS Despite the heterogeneous nature of WON in severe acute pancreatitis, a proposed QNI system may provide a standardized framework for WON classification to inform clinical trials, risk-stratify the disease course, and potentially inform an optimal management approach.
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Affiliation(s)
- Serge Baroud
- Department of Internal Medicine, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fateh Bazerbachi
- St Cloud Interventional Endoscopy Program, CentraCare, St Cloud Hospital, St Cloud, Minnesota, USA
| | - Aliana Bofill-Garcia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rabih Ghazi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel B Maselli
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Santhi Swaroop Vege
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naoki Takahashi
- Division of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark D Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Jegatheeswaran S, Finch LM, Siriwardena MC, Siriwardena AK. The terminology of the 2012 Atlanta consensus conference on post-inflammatory collections after acute pancreatitis: An assessment of utilization in practice. Hepatobiliary Pancreat Dis Int 2022; 21:508-510. [PMID: 34789411 DOI: 10.1016/j.hbpd.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Santhalingam Jegatheeswaran
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Louise M Finch
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | | | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Cucuteanu B, Negru D, Gavrilescu O, Popa IV, Floria M, Mihai C, Cijevschi Prelipcean C, Dranga M. Extrapancreatic necrosis volume: A new tool in acute pancreatitis severity assessment? World J Clin Cases 2021; 9:9395-9405. [PMID: 34877275 PMCID: PMC8610849 DOI: 10.12998/wjcc.v9.i31.9395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/16/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset. The extrapancreatic necrosis volume is a novel, promising score that appears to be superior to other scores investigated so far.
AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.
METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology, St Spiridon Hospital between January 1, 2017 and December 31, 2019 were analyzed retrospectively. Pancreatitis was classified according to the revised Atlanta classification (rAC) as mild, moderate, or severe. Severity was also evaluated by computed tomography and classified according to the computed tomography severity index (CTSI) and the modified CTSI (mCTSI). The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.
RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC (r = 0.926, P < 0.001 and r = 0.950, P < 0.001; r = 0.784, P < 0.001, respectively). The correlation of C-reactive protein with severity was positive but not as strong, and was not significant (r = 0.133, P = 0.154). The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume [area under the curve (AUC) = 0.993; 95% confidence interval (CI): 0.981-1.005], with a 99.5% sensitivity and 99.0% specificity at a cutoff value of 167 mL, followed by the mCTSI 2007 score (AUC = 0.972; 95%CI: 0.946-0.999), with a 98.0% sensitivity and 96.5% specificity, and the CTSI 1990 score (AUC = 0.969; 95%CI: 0.941-0.998), with a 97.0% sensitivity and 95.0% specificity.
CONCLUSION Radiological severity scores correlate strongly and positively with disease activity. Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.
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Affiliation(s)
- Bogdan Cucuteanu
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Dragoş Negru
- Department of Radiology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Otilia Gavrilescu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Iolanda Valentina Popa
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi City 700115, Romania
| | - Cătălina Mihai
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
| | - Mihaela Dranga
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, “Saint Spiridon” Hospital, Iaşi City 700115, Romania
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Ha J, Choi SH, Byun JH, Kim KW, Kim SY, Kim JH, Kim HJ. Meta-analysis of CT and MRI for differentiation of autoimmune pancreatitis from pancreatic adenocarcinoma. Eur Radiol 2020; 31:3427-3438. [PMID: 33146798 DOI: 10.1007/s00330-020-07416-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/28/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically determine the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC), with a comparison between the two imaging modalities. METHODS Literature search was conducted using PubMed and EMBASE databases to identify original articles published between 2009 and 2019 reporting the diagnostic performance of CT and MRI for differentiating AIP from PDAC. The meta-analytic sensitivity and specificity of CT and MRI were calculated, and compared using a bivariate random effects model. Subgroup analysis for differentiating focal AIP from PDAC was performed. RESULTS Of the 856 articles screened, 11 eligible articles are remained, i.e., five studies for CT, four for MRI, and two for both. The meta-analytic summary sensitivity and specificity of CT were 59% (95% confidence interval [CI], 41-75%) and 99% (95% CI, 88-100%), respectively, while those of MRI were 84% (95% CI, 68-93%) and 97% (95% CI, 87-99%). MRI had a significantly higher meta-analytic summary sensitivity than CT (84% vs. 59%, p = 0.02) but a similar specificity (97% vs. 99%, p = 0.18). In the subgroup analysis for focal AIP, the sensitivity for distinguishing between focal AIP and PDAC was lower than that for the overall analysis. MRI had a higher sensitivity than CT (76% vs. 50%, p = 0.28) but a similar specificity (97% vs. 98%, p = 0.07). CONCLUSION MRI might be clinically more useful to evaluate patients with AIP, particularly for differentiating AIP from PDAC. KEY POINTS • MRI had an overall good diagnostic performance to differentiate AIP from PDAC with a meta-analytic summary estimate of 83% for sensitivity and of 97% for specificity. • CT had a very high specificity (99%), but a suboptimal sensitivity (59%) for differentiating AIP from PDAC. • Compared with CT, MRI had a higher sensitivity, but a similar specificity.
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Affiliation(s)
- Jiyeon Ha
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Sang Hyun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea.
| | - Jae Ho Byun
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Kyung Won Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Jin Hee Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
| | - Hyoung Jung Kim
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, South Korea
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Utrera Pérez E, Tárdaguila de la Fuente G, Martínez Rodríguez C, Villanueva Campos A, Jurado Basildo C, García Pouton N. Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Utrera Pérez E, Tárdaguila de la Fuente G, Martínez Rodríguez C, Villanueva Campos A, Jurado Basildo C, García Pouton N. Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda. RADIOLOGIA 2020; 62:360-364. [DOI: 10.1016/j.rx.2019.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023]
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Paul J. Recent Advances in Diagnosis and Severity Assessment of Acute Pancreatitis. Prague Med Rep 2020; 121:65-86. [DOI: 10.14712/23362936.2020.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012). Multiple criteria and scoring systems have been used for assessment of severity of AP. Majority of acute pancreatitis cases (80%) are mild, the challenge remains in early diagnosis, severity assessment and treatment of severe AP and its complications. Assessment of severity of AP is important part of management because line of treatment depends on aetiology and severity of acute pancreatitis. In this article a comprehensive review of recent advances in diagnosis and severity assessment of acute pancreatitis has been described.
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Role of extrapancreatic necrosis volume in determining early prognosis in patients with acute pancreatitis. Abdom Radiol (NY) 2020; 45:1507-1516. [PMID: 31428812 DOI: 10.1007/s00261-019-02188-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aims to evaluate the capacity of the clinical and radiological findings and the extrapancreatic necrotic tissue volume in early (2-6 days) computerized tomography (CT) images of patients diagnosed with AP to predict reliably the temporary or permanent organ failure and other local or systemic complications due to pancreatitis. MATERIALS AND METHODS Adult patients who were diagnosed with AP based on Revised Atlanta classification and underwent abdomen CT scans between May 2015 and May 2018 were examined retrospectively. Extrapancreatic necrosis volume was compared to various clinical parameters that indicate the prognosis of AP such as C-reactive protein (CRP) at 48-72th h, organ failure, infection, requirement for percutaneous or surgical intervention, length of hospital stay, and mortality, and to various imaging-based scoring systems such as the computerized tomography severity index (CTSI) and the modified CTSI (mCTSI). The receiver operating characteristic (ROC) curve was used to estimate the optimal threshold for predicting clinical prognosis. RESULTS Extrapancreatic necrosis volume had moderate positive correlation with length of hospital stay (p = 0.0001) and CRP (at 48-72th h) (p = 0.0001) and strong positive correlation with CTSI (p = 0.0001), mCTSI (p = 0.0001), and white blood cell count (p = 0.0001). CONCLUSION Extrapancreatic necrosis volume was found to be particularly better in predicting organ failure and infection compared to the imaging-based scoring systems (Balthazar, CTSI, and mCTSI) and the laboratory-based scoring systems (CRP at 48-72th h).
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Yanagiya R, Suzuki T, Nakamura S, Fujita K, Oyama M, Okuyama A, Sugasawa K, Nakayama T, Suzuki Y, Ishizawa K, Saito S. TAFRO Syndrome Presenting with Retroperitoneal Panniculitis-like Computed Tomography Findings at Disease Onset. Intern Med 2020; 59:997-1000. [PMID: 31839656 PMCID: PMC7184093 DOI: 10.2169/internalmedicine.3740-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TAFRO syndrome is rare, and its pathophysiology remains unclear. We herein report the case of a 66-year-old man who presented at our emergency department with epigastric pain. Contrast-enhanced computed tomography (CT) showed high-density retroperitoneal panniculus with contrast enhancement. He was treated initially with a protease inhibitor and hydration, to little effect. Anasarca, thrombocytopenia, and renal dysfunction developed gradually, and TAFRO syndrome was diagnosed. He was treated successfully with prednisolone and cyclophosphamide, and subsequent CT findings showed improvement. Abnormal CT findings of the retroperitoneum may indicate the early stages of TAFRO syndrome before the presentation of typical ascites.
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Affiliation(s)
- Ryo Yanagiya
- Department of Internal Medicine, Nihonkai General Hospital, Japan
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd internal medicine), Yamagata University Faculty of Medicine, Japan
| | - Takuma Suzuki
- Department of Internal Medicine, Okitama Public General Hospital, Japan
| | - Shuhei Nakamura
- Department of Gastroenterology, Nihonkai General Hospital, Japan
| | - Kotaro Fujita
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Midori Oyama
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Ayumi Okuyama
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Kunie Sugasawa
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | | | - Yoshihiro Suzuki
- Department of Gastroenterology, Nihonkai General Hospital, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd internal medicine), Yamagata University Faculty of Medicine, Japan
| | - Soichi Saito
- Department of Internal Medicine, Nihonkai General Hospital, Japan
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Song YS, Park HS, Yu MH, Kim YJ, Jung SI. Prediction of Necrotizing Pancreatitis on Early CT Based on the Revised Atlanta Classification. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:1436-1447. [PMID: 36237716 PMCID: PMC9431828 DOI: 10.3348/jksr.2020.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022]
Abstract
Purpose To investigate the clinical and CT features at admission to predict the progression to necrotizing pancreatitis (NP) in patients initially diagnosed with interstitial edematous pancreatitis (IEP). Materials and Methods Patients with IEP who underwent contrast-enhanced CT at admission and follow-up CT (< 14 days) were included (n = 178). Two radiologists performed a consensus review of follow-up CT scans and diagnosed the type of acute pancreatitis as IEP or NP. Laboratory findings at admission were recorded. Clinical, CT, and laboratory findings were compared between the IEP-IEP group and IEP-NP group using the chi-square test and the t-test. Multivariate analysis was also performed. Results There were 112 and 66 patients in the IEP-IEP and the IEP-NP groups, respectively. The proportion of patients with alcohol etiology was significantly larger in the IEP-NP group. Among the CT findings, the presence of peripancreatic fluid and heterogeneous parenchymal enhancement were more frequently observed in the IEP-NP group. Among the laboratory variables, serum C-reactive protein levels and white blood cell counts were significantly higher in the IEP-NP group. Multivariate analysis revealed that the presence of peripancreatic fluid and heterogeneous parenchymal enhancement were significant findings distinguishing the two groups. Conclusion CT findings, such as the presence of peripancreatic fluid and heterogeneous pancreatic parenchymal enhancement, may be helpful in predicting the progression to NP in patients initially diagnosed with IEP.
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Affiliation(s)
- Yeon Seon Song
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
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Padu G, Lal P, Vindal A. Comparison of Modified Atlanta Classification With Modified CT Severity Index in Acute Gallstone Pancreatitis. MAMC JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/mamcjms.mamcjms_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cao X, Wang HM, Du H, Chen EX, Yang XF, Wang SL, Ding Y, She ZF. Early predictors of hyperlipidemic acute pancreatitis. Exp Ther Med 2018; 16:4232-4238. [PMID: 30344698 DOI: 10.3892/etm.2018.6713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes. The patients were divided into pairs groups: IPN and non-IPN, as well as OF and non-OF, and differences between the groups were determined regarding various clinicopathological parameters. Furthermore, univariate and multivariate regression analyses were performed to identify parameters associated with the risk of progression to IPN or OP. On univariate analysis, the following parameters were deemed as being significantly associated with the risk of IPN: Serum calcium ions, C-reactive protein (CRP), extent of necrosis, procalcitonin (PTC) and the MCTSI. Furthermore, calcium ions, red cell distribution width (RDW), extent of necrosis and the MCTSI were significantly associated with the risk of OF on univariate analysis. Multivariate logistic regression analysis for these parameters then indicated that CRP (P=0.014), RDW (P=0.025) and the extent of necrosis (P=0.022) were significant and independent predictors of progression; thus, these are early risk factors for patients with HLAP. Receiver operating characteristic curves were generated to evaluate the predictive value of these factors, and the area under the curve for the three parameters was 0.863 [95% confidence interval (CI), 0.646-0.886], 0.727 (95% CI, 0.651-0.803) and 0.833 (95% CI, 0.739-0.936), respectively. Therefore, CRP, RDW and the extent of necrosis are early predictive indexes for the risk of progression in HLAP.
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Affiliation(s)
- Xi Cao
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Huai-Ming Wang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Hai Du
- CT-MRI Room, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Er-Xia Chen
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Xiu-Feng Yang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Shi-Long Wang
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Ya Ding
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
| | - Zhan-Fei She
- Department of General Surgery, Ordos Central Hospital, Ordos, Inner Mongolia 017000, P.R. China
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Tang MY, Chen TW, Bollen TL, Wang YX, Xue HD, Jin ZY, Huang XH, Xiao B, Li XH, Ji YF, Zhang XM. MR imaging of hemorrhage associated with acute pancreatitis. Pancreatology 2018; 18:363-369. [PMID: 29615311 DOI: 10.1016/j.pan.2018.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To study MRI findings of hemorrhage in acute pancreatitis (AP) and correlate the presence and extent of hemorrhage with the MR severity index (MRSI), Acute Physiology And Chronic Health Evaluation (APACHE) II scores, and clinical outcome. MATERIALS AND METHODS This retrospective study included 539 patients with AP. Hemorrhage was defined as areas of hyperintensity in or outside the pancreas on liver imaging with volume acceleration flexible (LAVA-Flex). The presence of hemorrhage was classified into three areas: within the pancreatic parenchyma, retroperitoneal space, and sub-or intraperitoneal space. Involvement of each area was awarded 1 point resulting in the hemorrhage severity index (HSI) score. The predicted severity of AP was graded by MRSI and APACHE II score. The association between HSI, MRSI, and APACHE II scores was analyzed. The length of hospital stay and organ dysfunction was used as clinical outcome parameters. RESULTS Among 539 AP patients, 62 (11.5%) had hemorrhage. The prevalence of hemorrhage was 1.1% (2/186), 13.9% (43/310), and 39.5% (17/43) in predicted mild, moderate, and severe AP, respectively, based on MRSI (χ2 = 55.3, p = 0.00); and 7.7% (21/273) and 19.2% (18/94) in predicted mild and severe AP, respectively, based on APACHE II (χ2 = 21.2, p = 0.00). HSI score significantly correlated with MRSI (r = 0.36, p < 0.001) and APACHE II scores (r = 0.21, p = 0.00). The prevalence of organ dysfunction was higher and length of hospital stay was longer in patients with hemorrhage than in those without hemorrhage (p < 0.01). CONCLUSIONS Hemorrhage in AP is common. The presence of hemorrhage, rather than its extent, correlates with poor clinical outcome.
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Affiliation(s)
- Meng Yue Tang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Tian Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Yi Xiang Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital Shatin, Hong Kong SAR 999077, Hong Kong
| | - Hua Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao Hua Huang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Bo Xiao
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Xing Hui Li
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Yi Fan Ji
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China
| | - Xiao Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 63, Nanchong 637000, Sichuan, PR China.
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15
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Joshi G, Crawford KA, Hanna TN, Herr KD, Dahiya N, Menias CO. US of Right Upper Quadrant Pain in the Emergency Department: Diagnosing beyond Gallbladder and Biliary Disease. Radiographics 2018; 38:766-793. [DOI: 10.1148/rg.2018170149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gayatri Joshi
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Kevin A. Crawford
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Tarek N. Hanna
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Keith D. Herr
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Nirvikar Dahiya
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
| | - Christine O. Menias
- From the Department of Radiology and Imaging Sciences (G.J., K.A.C., T.N.H., K.D.H.) and Department of Emergency Medicine (G.J., T.N.H., K.D.H.), Emory University School of Medicine, 550 Peachtree St, Atlanta, GA 30308; and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (N.D., C.O.M.)
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16
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Baxter KA, Pucher PH, Berry DP, Elberm H, Abu-Hilal M, Marangoni G, Hamady ZZR. The effect of non-steroidal anti-inflammatory drugs on severity of acute pancreatitis and pancreatic necrosis. Ann R Coll Surg Engl 2018; 100:199-202. [PMID: 29181999 PMCID: PMC5930090 DOI: 10.1308/rcsann.2017.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction Acute pancreatitis (AP) is a common emergency presentation and can be disabling. There is significant morbidity and mortality associated with AP, and it places a considerable burden on the healthcare system. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have a protective effect in some elective contexts. This retrospective study aimed to evaluate the effect of NSAIDs on the course of AP and the severity of the disease. Methods A retrospective analysis was carried out of 324 patients admitted as an emergency with a diagnosis of AP to two UK hospitals. Patients were divided into two groups: those already taking NSAIDs for other co-morbidities and those not taking NSAIDs. Variables compared included: admission to a high dependency or intensive care unit; pancreatic necrosis; pseudocyst development; need for surgery; serum inflammatory markers; modified early warning scores on days 1, 3 and 5; length of stay; and mortality. Results Patients not taking NSAIDs were more likely to have a C-reactive protein level of ≥150mg/l (p=0.007). Patients in the NSAID group experienced less pancreatic necrosis (p=0.019) and lower rates of pseudocyst formation (p=0.010). Other variables showed no difference between the two groups, specifically length of stay and mortality. Conclusions Routine NSAID use may exert a protective effect on the development of AP, its severity, and complications. Therapeutic use of NSAIDs in acute presentations with pancreatitis should be further evaluated.
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Affiliation(s)
- KA Baxter
- University Hospital Southampton NHS Foundation Trust, UK
| | - PH Pucher
- University Hospital Southampton NHS Foundation Trust, UK
| | - DP Berry
- University Hospital Southampton NHS Foundation Trust, UK
| | - H Elberm
- University Hospital Southampton NHS Foundation Trust, UK
| | - M Abu-Hilal
- University Hospital Southampton NHS Foundation Trust, UK
| | - G Marangoni
- University Hospital Coventry and Warwickshire NHS Trust, UK
| | - ZZR Hamady
- University Hospital Southampton NHS Foundation Trust, UK
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17
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Clinically Acceptable Optimized Dose Reduction in Computed Tomographic Imaging of Necrotizing Pancreatitis Using a Noise Addition Software Tool. J Comput Assist Tomogr 2018; 42:197-203. [DOI: 10.1097/rct.0000000000000684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Reid GP, Williams EW, Francis DK, Lee MG. Acute pancreatitis: A 7 year retrospective cohort study of the epidemiology, aetiology and outcome from a tertiary hospital in Jamaica. Ann Med Surg (Lond) 2017; 20:103-108. [PMID: 28808565 PMCID: PMC5537196 DOI: 10.1016/j.amsu.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalisation. There was previously a dearth of studies exploring the incidence, risk factors and outcome of AP in the Caribbean region. MATERIALS AND METHODS All patients with a diagnosis of AP admitted to the University Hospital of the West Indies (UHWI) between 2006 and 2012 were reviewed. The epidemiological profile, risk factors, clinical presentation and outcomes of patients with AP were retrospectively studied. RESULTS There were 70 females and 21 males with a median age of 44 years (range 2-86). The median age of males was significantly higher than that of females (p = 0.041). The incidence of AP was 74 per 100,000 admissions per year. Vomiting and abdominal tenderness were noted in the majority of patients. The most common aetiology was biliary disease (71.4%), idiopathic (12%), post-ERCP (6.6%) and alcohol (5.5%). Alcoholic pancreatitis was only seen in males whereas idiopathic and post-ERCP pancreatitis only occurred in females. The mean duration of hospitalisation was 9.51 ± 8.28 days. Disease severity was mild in 61.1%, moderately severe in 26.7%, and severe in 12.2% of patients. Factors associated with more severe disease included overweight/obesity, idiopathic aetiology and post-ERCP status. The case fatality rate was 2%. CONCLUSION The incidence of AP was 74/100,000 hospital admissions annually. There was an unusual female preponderance, with biliary pancreatitis being the most common type occurring at an equal frequency among males and females. Only 12.2% of the total cases seen were severe. The case fatality rate was 2%. Local health policy should target timely interventions for biliary pancreatitis and should also address the local factors affecting disease severity.
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Affiliation(s)
- Gail P Reid
- Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia & Intensive Care, The University Hospital of the West Indies, Mona, Jamaica
| | - Eric W Williams
- Emergency Medicine Division, Department of Surgery, Radiology, Anaesthesia & Intensive Care, The University Hospital of the West Indies, Mona, Jamaica
| | - Damian K Francis
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Jamaica
| | - Michael G Lee
- Department of Medicine, The University Hospital of the West Indies, Mona, Jamaica
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The diagnostic challenge of the sequelae of acute pancreatitis on CT imaging: a pictorial essay. Abdom Radiol (NY) 2017; 42:1199-1209. [PMID: 27873041 DOI: 10.1007/s00261-016-0986-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of the study was to present a pictorial review of the long-term sequelae of acute pancreatitis on CT imaging as these findings can cause diagnostic confusion in the absence of a proper clinical history and/or prior CT imaging. METHODS We retrospectively identified 81 patients who had an episode of acute pancreatitis with diagnostic findings on CT and also underwent one or more follow-up CT scans at least 1 month beyond the acute episode. The residual findings on all follow-up CT scans were tabulated, including the time interval since the initial bout of acute pancreatitis. RESULT Residual inflammatory changes were present in 19.8% of cases, with a median time period lasting 86 days since the initial episode of acute pancreatitis. Residual fluid collections were seen in 27.2% and persisted for a median of 132 days. Three patients had residual solid-appearing inflammatory masses, which could be mistaken for neoplasms. Other long-term sequelae were also tabulated, including pancreatic ductal dilatation, pancreatic atrophy, new or increased pancreatic calcifications, biliary tract dilatation, central portal venous occlusion, and pseudoaneurysm formation. These residual findings and long-term complications are presented as a pictorial essay. CONCLUSION Recognizing the spectrum of residual findings of acute pancreatitis, some of which can be long term, is important in the correct interpretation of a pancreatic CT. These findings can mimic acute pancreatitis or a pancreatic/peripancreatic neoplasm and often cause diagnostic confusion, especially in the absence of prior CT imaging.
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20
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Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. Radiographics 2017; 36:675-87. [PMID: 27163588 DOI: 10.1148/rg.2016150097] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The 2012 revised Atlanta classification is an update of the original 1992 Atlanta classification, a standardized clinical and radiologic nomenclature for acute pancreatitis and associated complications based on research advances made over the past 2 decades. Acute pancreatitis is now divided into two distinct subtypes, necrotizing pancreatitis and interstitial edematous pancreatitis (IEP), based on the presence or absence of necrosis, respectively. The revised classification system also updates confusing and sometimes inaccurate terminology that was previously used to describe pancreatic and peripancreatic collections. As such, use of the terms acute pseudocyst and pancreatic abscess is now discouraged. Instead, four distinct collection subtypes are identified on the basis of the presence of pancreatic necrosis and time elapsed since the onset of pancreatitis. Acute peripancreatic fluid collections (APFCs) and pseudocysts occur in IEP and contain fluid only. Acute necrotic collections (ANCs) and walled-off necrosis (WON) occur only in patients with necrotizing pancreatitis and contain variable amounts of fluid and necrotic debris. APFCs and ANCs occur within 4 weeks of disease onset. After this time, APFCs or ANCs may either resolve or persist, developing a mature wall to become a pseudocyst or a WON, respectively. Any collection subtype may become infected and manifest as internal gas, though this occurs most commonly in necrotic collections. In this review, the authors present a practical image-rich guide to the revised Atlanta classification system, with the goal of fostering implementation of the revised system into radiology practice, thereby facilitating accurate communication among clinicians and reinforcing the radiologist's role as a key member of a multidisciplinary team in treating patients with acute pancreatitis. (©)RSNA, 2016.
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Affiliation(s)
- Bryan R Foster
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Kyle K Jensen
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Gene Bakis
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Fergus V Coakley
- From the Department of Diagnostic Radiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (B.R.F., K.K.J., G.B., F.V.C.); and Department of Radiology, University of Utah, Salt Lake City, Utah (A.M.S.)
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Hua Z, Su Y, Huang X, Zhang K, Yin Z, Wang X, Liu P. Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis: a retrospective study of 344 cases in a single Chinese center. BMC Gastroenterol 2017; 17:29. [PMID: 28193160 PMCID: PMC5307753 DOI: 10.1186/s12876-017-0587-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gastrointestinal fistula (GIF) in severe acute pancreatitis (SAP) is considered as a sparse episode and studied sporadically in the literature. There is paucity of data on the prediction of the effect on risk of GIF in patient with SAP. This study was aimed to investigate risk factors related to GIF in the development of SAP. METHODS The clinical data of 344 patients with SAP from 2011 to 2016 were reviewed retrospectively. All patients were divided into the GIF group and the non-GIF group, and their data analyzed with respect to 15 parameters were applied to explore potential risk factors for GIF in patients with SAP. RESULTS Of the 344 eligible patients, 52 (15.12%) progressed to GIF. Only occurrence of infected pancreatic and extra-pancreatic necrosis (IPN) (P = 0.004, OR = 3.012) and modified CT severity index (MCTSI) (P = 0.033, OR = 1.183) were proved to be independent risk factors for GIF in patients with SAP, and blood type B (P = 0.048, OR = 2.096, 95% CI: 0.748-3.562) indicated weaker association of risk factor for GIF. The early (48-72 h after admission) enteral nutrition (EEN) (P = 0.016, OR = 0.267) acted as a protective factor. CONCLUSIONS Occurrence of IPN and high MCTSI are independent risk factors for the development of GIF in patients with SAP, blood type B reveals a potential correlation with GIF in patients with SAP. EEN is helpful to prevent the progression of GIF secondary to SAP.
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Affiliation(s)
- Zhipeng Hua
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Yongjie Su
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Xuefeng Huang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China
| | - Kang Zhang
- Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Zhengyu Yin
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Xiaoming Wang
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China.,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China
| | - Pingguo Liu
- Department of Hepatobiliary Surgery, Zhongshan Hospital of Xiamen University, Hubing South Road, Xiamen, Fujian, China. .,Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma (Xiamen University Affiliated ZhongShan Hospital), Xiamen, China.
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Avanesov M, Weinrich JM, Kraus T, Derlin T, Adam G, Yamamura J, Karul M. MDCT of acute pancreatitis: Intraindividual comparison of single-phase versus dual-phase MDCT for initial assessment of acute pancreatitis using different CT scoring systems. Eur J Radiol 2016; 85:2014-2022. [PMID: 27776654 DOI: 10.1016/j.ejrad.2016.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of the retrospective study was to evaluate the additional value of dual-phase multidetector computed tomography (MDCT) protocols over a single-phase protocol on initial MDCT in patients with acute pancreatitis using three CT-based pancreatitis severity scores with regard to radiation dose. METHODS In this retrospective, IRB approved study MDCT was performed in 102 consecutive patients (73 males; 55years, IQR48-64) with acute pancreatitis. Inclusion criteria were CT findings of interstitial edematous pancreatitis (IP) or necrotizing pancreatitis (NP) and a contrast-enhanced dual-phase (arterial phase and portal-venous phase) abdominal CT performed at ≥72h after onset of symptoms. The severity of pancreatic and extrapancreatic changes was independently assessed by 2 observers using 3 validated CT-based scoring systems (CTSI, mCTSI, EPIC). All scores were applied to arterial phase and portal venous phase scans and compared to score results of portal venous phase scans, assessed ≥14days after initial evaluation. For effective dose estimation, volume CT dose index (CTDIvol) and dose length product (DLP) were recorded in all examinations. RESULTS In neither of the CT severity scores a significant difference was observed after application of a dual-phase protocol compared with a single-phase protocol (IP: CTSI: 2.7 vs. 2.5, p=0.25; mCTSI: 4.0 vs. 4.0, p=0.10; EPIC: 2.0 vs. 2.0, p=0.41; NP: CTSI: 8.0 vs. 7.0, p=0.64; mCTSI: 8.0 vs. 8.0, p=0.10; EPIC: 3.0 vs. 3.0, p=0.06). The application of a single-phase CT protocol was associated with a median effective dose reduction of 36% (mean dose reduction 31%) compared to a dual-phase CT scan. CONCLUSIONS An initial dual-phase abdominal CT after ≥72h after onset of symptoms of acute pancreatitis was not superior to a single-phase protocol for evaluation of the severity of pancreatic and extrapancreatic changes. However, the effective radiation dose may be reduced by 36% using a single-phase protocol.
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Affiliation(s)
- Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julius M Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kraus
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Murat Karul
- Department of Diagnostic and Interventional Radiology, Marienkrankenhaus Hamburg, Germany
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Sternby H, Verdonk RC, Aguilar G, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Lantto E, Loigom T, Penttilä A, Regnér S, Rosendahl J, Strahinova V, Zackrisson S, Zviniene K, Bollen TL. Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis - An international multicenter evaluation of the revised Atlanta classification. Pancreatology 2016; 16:791-7. [PMID: 27592205 DOI: 10.1016/j.pan.2016.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/14/2016] [Accepted: 08/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. METHODS Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. RESULTS In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P < 0.0001) and non-homogeneous collections (35% versus 66%, P < 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. CONCLUSION Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings.
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Affiliation(s)
- Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Robert C Verdonk
- Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine "Pirogov", Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Eila Lantto
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Tonis Loigom
- Department of Radiology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne Penttilä
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Jonas Rosendahl
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, Leipzig, Germany
| | - Vanya Strahinova
- Department of Emergency Radiology, University Hospital for Emergency Medicine "Pigorov", Sofia, Bulgaria
| | - Sophia Zackrisson
- Department of Radiology, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Kristina Zviniene
- Department of Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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Chi XX, Chen TW, Huang XH, Yang L, Tang W, Wáng YXJ, Xiao B, Zhang XM. Magnetic resonance imaging of retroperitoneal interfascial plane involvement in acute pancreatitis. Quant Imaging Med Surg 2016; 6:250-8. [PMID: 27429909 DOI: 10.21037/qims.2016.06.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To study the magnetic resonance imaging (MRI) features of acute pancreatitis (AP) involving the retroperitoneal interfascial planes and to analyze the correlations of interfascial plane involvement with the magnetic resonance severity index (MRSI) and the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system. METHODS A total of 316 consecutive patients with AP between November 2011 and August 2013 were retrospectively analyzed. The extension and path of the inflammation spreading along the retroperitoneal interfascial plane on MRI were graded from grade 0 to grade 5. The relationships between interfascial plane involvement and MRSI and APACHE II were analyzed. RESULTS Of the 316 patients with AP, 293 patients (92.7%) had interfascial plane involvement, which appeared as interfascial plane edema, thickening and effusion. There were 60, 105, 78, 25, and 25 patients in grades 1, 2, 3, 4, and 5, respectively. Interfascial plane involvement strongly correlated with the MRSI score (r=0.703), but was only weakly correlated with the APACHE-II score (r=0.291). CONCLUSIONS MRI depicts the characteristics of interfascial plane involvement in AP. The value of interfascial plane involvement for determining the disease severity is likely to be limited.
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Affiliation(s)
- Xiao-Xiao Chi
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai 264000, China
| | - Tian-Wu Chen
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Hua Huang
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Lin Yang
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Wei Tang
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Yì-Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong SAR, China
| | - Bo Xiao
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Xiao-Ming Zhang
- Sichuan Key laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Artesunate ameliorates severe acute pancreatitis (SAP) in rats by inhibiting expression of pro-inflammatory cytokines and Toll-like receptor 4. Int Immunopharmacol 2016; 38:252-60. [PMID: 27318790 DOI: 10.1016/j.intimp.2016.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/08/2016] [Accepted: 06/11/2016] [Indexed: 02/06/2023]
Abstract
Severe acute pancreatitis (SAP) is a severe clinical condition with significant morbidity and mortality. Multiple organs dysfunction (MOD) is the leading cause of SAP-related death. The over-release of pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α is the underlying mechanism of MOD; however, there is no effective agent against the inflammation. Herein, artesunate (AS) was found to increase the survival of SAP rats significantly when injected with 3.5% sodium taurocholate into the biliopancreatic duct in a retrograde direction, improving their pancreatic pathology and decreasing serum amylase and pancreatic lipase activities along with substantially reduced pancreatic IL-1β and IL-6 release. In vitro, AS-pretreatment strongly inhibited IL-1β and IL-6 release and their mRNA expressions in the pancreatic acinar cells treated with lipopolysaccharide (LPS) but exerted little effect on TNF-α release. Additionally, AS reduced the mRNA expressions of Toll-like receptor 4 (TLR4) and nuclear factor-κB (NF-κB) p65 as well as their protein expressions in the pancreatic acinar cells. In conclusion, our results demonstrated that AS could significantly protect SAP rats, and this protection was related to the reduction of digestive enzyme activities and pro-inflammatory cytokine expressions via inhibition of TLR4/NF-κB signaling pathway. Therefore, AS may be considered as a potential therapeutic agent against SAP.
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Yadav AK, Sharma R, Kandasamy D, Bhalla AS, Gamanagatti S, Srivastava DN, Upadhyay AD, Garg PK. Perfusion CT: can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis? ACTA ACUST UNITED AC 2015; 40:488-99. [PMID: 25173791 DOI: 10.1007/s00261-014-0226-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Pancreatic necrosis is an important determinant of patient outcome in severe acute pancreatitis (SAP). This prospective study was conducted to evaluate if perfusion CT (PCT) can predict the development of necrosis at an early stage in SAP. METHODS PCT was performed within 72 h of abdominal pain in 57 consecutive admitted patients of acute pancreatitis, out of which four patients were excluded. Thirty-two patients were classified as SAP and 21 as mild acute pancreatitis (MAP) on the basis of APACHE II or SIRS criteria or presence of organ failure. All patients underwent a follow-up CECT at 3 weeks to look for pancreatic necrosis. RESULTS Out of 32 patients of SAP, 14 patients showed perfusion defects. The mean blood flow (BF) in these areas was 11.47 ± 5.56 mL/100 mL/min and median blood volume (BV) was 3.92 mL/100 mL (0.5-8.49 mL/100 mL). All these patients developed necrosis on follow-up scan. Two patients who did not show perfusion defects also developed necrosis. Remaining 37 patients (16 SAP and 21 MAP) did not show perfusion defect and did not develop necrosis on follow-up. All regions showing BF less than ≤23.45 mL/100 mL/min and BV ≤8.49 mL/100 mL developed pancreatic necrosis. The values of perfusion parameters may vary with the scanner, mathematical model and protocol used. The sensitivity and specificity of PCT for predicting pancreatic necrosis were 87.5% and 100%, respectively. The cut off values of BF and BV for predicting the development of pancreatic necrosis were 27.29 mL/100 mL/min and 8.96 mL/100 mL, respectively, based on ROC curve. PCT is a reliable tool for early prediction of pancreatic necrosis, which may open new avenues to prevent this ominous complication.
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Affiliation(s)
- Ajay Kumar Yadav
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India,
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Bollen TL. Acute pancreatitis: international classification and nomenclature. Clin Radiol 2015; 71:121-33. [PMID: 26602933 DOI: 10.1016/j.crad.2015.09.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Abstract
The incidence of acute pancreatitis (AP) is increasing and it is associated with a major healthcare concern. New insights in the pathophysiology, better imaging techniques, and novel treatment options for complicated AP prompted the update of the 1992 Atlanta Classification. Updated nomenclature for pancreatic collections based on imaging criteria is proposed. Adoption of the newly Revised Classification of Acute Pancreatitis 2012 by radiologists should help standardise reports and facilitate accurate conveyance of relevant findings to referring physicians involved in the care of patients with AP. This review will clarify the nomenclature of pancreatic collections in the setting of AP.
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Affiliation(s)
- T L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands.
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28
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Xenoulis PG. Diagnosis of pancreatitis in dogs and cats. J Small Anim Pract 2015; 56:13-26. [PMID: 25586803 DOI: 10.1111/jsap.12274] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/13/2014] [Accepted: 06/09/2014] [Indexed: 12/23/2022]
Abstract
Pancreatitis is the most common disorder of the exocrine pancreas in both dogs and cats. Ante-mortem diagnosis of canine and feline pancreatitis can be challenging. The clinical picture of dogs and cats with pancreatitis varies greatly (from very mild to severe or even fatal) and is characterised by non-specific findings. Complete blood count, serum biochemistry profile and urinalysis should always be performed in dogs and cats suspected of having pancreatitis, although findings are not-specific for pancreatitis. Serum amylase and lipase activities and trypsin-like immunoreactivity (TLI) concentrations have no or only limited clinical value for the diagnosis of pancreatitis in either dogs or cats. Conversely, serum pancreatic lipase immunoreactivity (PLI) concentration is currently considered to be the clinicopathological test of choice for the diagnosis of canine and feline pancreatitis. Abdominal radiography is a useful diagnostic tool for the exclusion of other diseases that may cause similar clinical signs to those of pancreatitis. Abdominal ultrasonography can be very useful for the diagnosis of pancreatitis, but this depends largely on the clinician's experience. Histopathological examination of the pancreas is considered the gold standard for the diagnosis and classification of pancreatitis, but it is not without limitations. In clinical practice, a combination of careful evaluation of the animal's history, serum PLI concentration and abdominal ultrasonography, together with pancreatic cytology or histopathology when indicated or possible, is considered to be the most practical and reliable means for an accurate diagnosis or exclusion of pancreatitis compared with other diagnostic modalities.
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Affiliation(s)
- P G Xenoulis
- Clinic of Medicine, Faculty of Veterinary Medicine, University of Thessaly, Karditsa 43100, Greece; Animal Medical Center of Athens, Athens, Greece
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Abstract
Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist.
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Affiliation(s)
- Ruedi F Thoeni
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical School, PO Box 2829, San Francisco, CA 94126-2829, USA.
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30
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Pezzilli R, Zerbi A, Campra D, Capurso G, Golfieri R, Arcidiacono PG, Billi P, Butturini G, Calculli L, Cannizzaro R, Carrara S, Crippa S, De Gaudio R, De Rai P, Frulloni L, Mazza E, Mutignani M, Pagano N, Rabitti P, Balzano G. Consensus guidelines on severe acute pancreatitis. Dig Liver Dis 2015; 47:532-43. [PMID: 25921277 DOI: 10.1016/j.dld.2015.03.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Abstract
This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
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Manikkavasakar S, AlObaidy M, Busireddy KK, Ramalho M, Nilmini V, Alagiyawanna M, Semelka RC. Magnetic resonance imaging of pancreatitis: An update. World J Gastroenterol 2014; 20:14760-14777. [PMID: 25356038 PMCID: PMC4209541 DOI: 10.3748/wjg.v20.i40.14760] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 06/02/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance (MR) imaging plays an important role in the diagnosis and staging of acute and chronic pancreatitis and may represent the best imaging technique in the setting of pancreatitis due to its unmatched soft tissue contrast resolution as well as non-ionizing nature and higher safety profile of intravascular contrast media, making it particularly valuable in radiosensitive populations such as pregnant patients, and patients with recurrent pancreatitis requiring multiple follow-up examinations. Additional advantages include the ability to detect early forms of chronic pancreatitis and to better differentiate adenocarcinoma from focal chronic pancreatitis. This review addresses new trends in clinical pancreatic MR imaging emphasizing its role in imaging all types of acute and chronic pancreatitis, pancreatitis complications and other important differential diagnoses that mimic pancreatitis.
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Sharma V, Rana SS, Sharma RK, Gupta R, Bhasin DK. Clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Gastroenterol Rep (Oxf) 2014; 3:144-7. [PMID: 25305375 PMCID: PMC4423459 DOI: 10.1093/gastro/gou067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/28/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Guidelines recommend that contrast-enhanced computed tomography (CT) should be carried out 72 hours after onset of an attack of acute pancreatitis (AP). However, the exact time beyond 72 hours at which CT will produce the best diagnostic yield for local complications, or whether doing a CT early in acute pancreatitis has any adverse effect on the course of disease, is not clear. METHODS The medical records of 214 consecutive patients with AP were analysed retrospectively and these patients were divided into two groups: the early CT group (CT done at 4-5 days after the onset of pain) and the late CT group (CT done in days 6-14 following onset of pain). The two groups were compared for differences in clinical outcomes and prognostic information obtained from CT, such as detection of pancreatic necrosis and local complications, and CT severity index. RESULTS Of 214 patients [143 (66.8%) males; mean age 39.87 ± 13.52 years], 21 patients were excluded as they did not undergo CT or CT was done more than 14 days after onset of an attack of AP. The early CT group included 114 patients, whilst the late CT group had 79. The mean CT severity index was higher in the late CT group (6.65 ± 2.27 vs. 5.52 ± 2.7; P = 0.005). The incidence of persistent organ failure in the early group was no different from that of the late group (38.6% vs. 49.4%; P = 0.143). Local complications were detected more often in the late CT group (84.8% vs. 68.4%; P = 0.011). There was no difference between the two groups in the need for percutaneous drainage, surgery, or mortality (all P > 0.05). CONCLUSIONS Although performing early CT does not adversely affect the outcome in AP, CT carried out more than 5 days after the onset of symptoms may detect more local complications.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ravi K Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajesh Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India and Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Busireddy KK, AlObaidy M, Ramalho M, Kalubowila J, Baodong L, Santagostino I, Semelka RC. Pancreatitis-imaging approach. World J Gastrointest Pathophysiol 2014; 5:252-270. [PMID: 25133027 PMCID: PMC4133524 DOI: 10.4291/wjgp.v5.i3.252] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/13/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatitis is defined as the inflammation of the pancreas and considered the most common pancreatic disease in children and adults. Imaging plays a significant role in the diagnosis, severity assessment, recognition of complications and guiding therapeutic interventions. In the setting of pancreatitis, wider availability and good image quality make multi-detector contrast-enhanced computed tomography (MD-CECT) the most used imaging technique. However, magnetic resonance imaging (MRI) offers diagnostic capabilities similar to those of CT, with additional intrinsic advantages including lack of ionizing radiation and exquisite soft tissue characterization. This article reviews the proposed definitions of revised Atlanta classification for acute pancreatitis, illustrates a wide range of morphologic pancreatic parenchymal and associated peripancreatic changes for different types of acute pancreatitis. It also describes the spectrum of early and late chronic pancreatitis imaging findings and illustrates some of the less common types of chronic pancreatitis, with special emphasis on the role of CT and MRI.
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Hollemans RA, van Brunschot S, Bakker OJ, Bollen TL, Timmer R, Besselink MGH, van Santvoort HC. Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Rev Med Devices 2014; 11:637-48. [DOI: 10.1586/17434440.2014.947271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Teshima CW, Sandha GS. Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease. World J Gastroenterol 2014; 20:9976-9989. [PMID: 25110426 PMCID: PMC4123377 DOI: 10.3748/wjg.v20.i29.9976] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/23/2014] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases. Furthermore, as EUS technology has advanced, it has increasingly become a therapeutic procedure, and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon. However, this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice. In particular, the diagnostic evaluation of acute pancreatitis, chronic pancreatitis, cystic pancreatic lesions and solid masses of the pancreas are discussed. The newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this context. The main therapeutic aspects of pancreatic EUS are then considered, namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer, and EUS-guided drainage of pancreatic fluid collections.
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Bakker OJ, Issa Y, van Santvoort HC, Besselink MG, Schepers NJ, Bruno MJ, Boermeester MA, Gooszen HG. Treatment options for acute pancreatitis. Nat Rev Gastroenterol Hepatol 2014; 11:462-9. [PMID: 24662281 DOI: 10.1038/nrgastro.2014.39] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This Review covers the latest developments in the treatment of acute pancreatitis. The Atlanta Classification of acute pancreatitis has been revised, proposing several new terms and abandoning some of the old and confusing terminology. The 2012 Revised Atlanta Classification and the determinant-based classification aim to universally define the different local and systemic complications and predict outcome. The most important differences between these classifications are discussed. Several promising treatment options for the early management of acute pancreatitis have been tested, including the use of enteral nutrition and antibiotics as well as novel therapies such as haemofiltration and protease inhibitors. The results are summarized and the quality of evidence is discussed. Finally, new developments in the management of patients with infected pancreatic necrosis are addressed, including the use of the 'step-up approach' and results of minimally invasive necrosectomy.
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Affiliation(s)
- Olaf J Bakker
- Department of Surgery, Room G04.228, University Medical Center Utrecht Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, Netherlands
| | - Yama Issa
- Department of Surgery (Suite G4-136), Academic Medical Center, Meibergdreef 9, 1105 AZ, PO Box 22660, 1100 DD Amsterdam, Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Room G04.228, University Medical Center Utrecht Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, Netherlands
| | - Marc G Besselink
- Department of Surgery (Suite G4-136), Academic Medical Center, Meibergdreef 9, 1105 AZ, PO Box 22660, 1100 DD Amsterdam, Netherlands
| | - Nicolien J Schepers
- Department of Gastroenterology &Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology &Hepatology, Erasmus Medical Center, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
| | - Marja A Boermeester
- Department of Surgery (Suite G4-136), Academic Medical Center, Meibergdreef 9, 1105 AZ, PO Box 22660, 1100 DD Amsterdam, Netherlands
| | - Hein G Gooszen
- Department of Operation Rooms/Evidence Based Surgery, Radboud University Medical Centre, Geert Grooteplein zuid 10, PO Box 9101, 6500 HB Nijmegen, Netherlands
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Classifications of acute pancreatitis: to Atlanta and beyond. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractUntil Atlanta Classification (AC) made in 1992, there was not any classification of acute pancreatitis (AP). Last twenty years AC let us compare results and papers. But the increasing understanding of the pathophysiology of AP, improvements in diagnostic methods and the development of minimally invasive tools for radiological, endoscopic and surgical management of local complications, several authors have called for the AC to be reviewed. Last months, two new classifications of AP have been published. We made a historical review of AC, the two new classifications and a comparison between them.
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Acute necrotizing pancreatitis: laboratory, clinical, and imaging findings as predictors of patient outcome. AJR Am J Roentgenol 2014; 202:1215-31. [PMID: 24848818 DOI: 10.2214/ajr.13.10936] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In patients with acute necrotizing pancreatitis, we analyzed whether laboratory and clinical findings determined in the early phase of disease and morphologic features on contrast-enhanced CT (CECT) at the beginning of the late phase of disease are helpful in predicting patient outcome and whether CECT findings provide additional information in establishing prognosis compared with the laboratory and clinical findings. MATERIALS AND METHODS A retrospective analysis of 99 patients with acute necrotizing pancreatitis was performed. Four laboratory variables (albumin, calcium, C-reactive protein, WBC count) and three clinical variables (Acute Physiology, Age, Chronic Health Evaluation [APACHE] II score; Simplified Acute Physiology Score [SAPS] II; persistent organ failure) were assessed. Five morphologic features on CECT including Balthazar grade and CT severity index were reviewed. The endpoints of patient outcome were peripancreatic or pancreatic infection, need for intervention, duration of organ failure, ICU and hospital stays, and death. Based on receiver operating characteristic curve analysis for infection, high-and low-risk groups for each prognostic variable were calculated and univariable and multivariable Cox regression analyses were carried out. RESULTS In our study population of 99 patients (63 men, 36 women; median age, 52 years; age range, 18-84 years), 25 patients (25%) developed infection, 42 patients (42%) experienced organ failure, and 12 patients (12%) died. Regarding the laboratory and clinical variables, albumin level, APACHE II score, and particularly persistent organ failure were the strongest independent predictors of patient outcome. Regarding the imaging variables, Balthazar grade and a morphologic feature that takes the distribution of intrapancreatic necrosis into account were the strongest independent predictors. In the multivariable analysis of all studied variables, imaging variables were independent and strong predictors of patient outcome and provided additional information in establishing prognosis compared with clinical and laboratory findings. CONCLUSION In patients with suspected or proven acute necrotizing pancreatitis, performing CECT at the beginning of the late phase of disease is recommended to identify patients at increased risk for adverse outcomes.
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Abstract
Magnetic resonance (MR) imaging of the pancreas is useful as both a problem-solving tool and an initial imaging examination of choice. With newer imaging sequences such as diffusion-weighted imaging, MR offers improved ability to detect and characterize lesions and identify and stage tumors and inflammation. MR cholangiopancreatography can be used to visualize the pancreatic and biliary ductal system. In this article, the use of MR to evaluate the pancreas, including recent advances, is reviewed and the normal appearance of the pancreas on different imaging sequences, as well as inflammatory diseases, congenital abnormalities, and neoplasms of the pancreas, are discussed.
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Affiliation(s)
- Erin O'Neill
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Nancy Hammond
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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da Costa DW, Boerma D, van Santvoort HC, Horvath KD, Werner J, Carter CR, Bollen TL, Gooszen HG, Besselink MG, Bakker OJ. Staged multidisciplinary step-up management for necrotizing pancreatitis. Br J Surg 2013; 101:e65-79. [DOI: 10.1002/bjs.9346] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 12/16/2022]
Abstract
Abstract
Background
Some 15 per cent of all patients with acute pancreatitis develop necrotizing pancreatitis, with potentially significant consequences for both patients and healthcare services.
Methods
This review summarizes the latest insights into the surgical and medical management of necrotizing pancreatitis. General management strategies for the treatment of complications are discussed in relation to the stage of the disease.
Results
Frequent clinical evaluation of the patient's condition remains paramount in the first 24–72 h of the disease. Liberal goal-directed fluid resuscitation and early enteral nutrition should be provided. Urgent endoscopic retrograde cholangiopancreatography is indicated when cholangitis is suspected, but it is unclear whether this is appropriate in patients with predicted severe biliary pancreatitis without cholangitis. Antibiotic prophylaxis does not prevent infection of necrosis and antibiotics are not indicated as part of initial management. Bacteriologically confirmed infections should receive targeted antibiotics. With the more conservative approach to necrotizing pancreatitis currently advocated, fine-needle aspiration culture of pancreatic or extrapancreatic necrosis will less often lead to a change in management and is therefore indicated less frequently. Optimal treatment of infected necrotizing pancreatitis consists of a staged multidisciplinary ‘step-up’ approach. The initial step is drainage, either percutaneous or transluminal, followed by surgical or endoscopic transluminal debridement only if needed. Debridement is delayed until the acute necrotic collection has become ‘walled-off’.
Conclusion
Outcome following necrotizing pancreatitis has improved substantially in recent years as a result of a shift from early surgical debridement to a staged, minimally invasive, multidisciplinary, step-up approach.
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Affiliation(s)
- D W da Costa
- Department of Operating Theatres and Evidence Based Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - D Boerma
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - H C van Santvoort
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - K D Horvath
- Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - J Werner
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C R Carter
- Department of Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - T L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - H G Gooszen
- Department of Operating Theatres and Evidence Based Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - M G Besselink
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - O J Bakker
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Maraví-Poma E, Patchen Dellinger E, Forsmark CE, Layer P, Lévy P, Shimosegawa T, Siriwardena AK, Uomo G, Whitcomb DC, Windsor JA, Petrov MS. [International multidisciplinary classification of acute pancreatitis severity: the 2013 Spanish edition]. Med Intensiva 2013; 38:211-7. [PMID: 23747189 DOI: 10.1016/j.medin.2013.03.013] [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: 02/13/2013] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop a new classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of the published evidence, and worldwide consultation. BACKGROUNDS The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of specialist in pancreatic diseases, but are suboptimal because these definitions are based on the empiric description of events not associated with severity. METHODS A personal invitation to contribute to the development of a new classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists and radiologists currently active in the field of clinical acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global web-based survey was conducted, and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. RESULTS The new classification of severity is based on the actual local and systemic determinants of severity, rather than on the description of events that are non-causally associated with severity. The local determinant relates to whether there is (peri) pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another, whereby the presence of both infected (peri) pancreatic necrosis and persistent organ failure has a greater impact upon severity than either determinant alone. The derivation of a classification based on the above principles results in four categories of severity: mild, moderate, severe, and critical. CONCLUSIONS This classification is the result of a consultative process among specialists in pancreatic diseases from 49 countries spanning North America, South America, Europe, Asia, Oceania and Africa. It provides a set of concise up to date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
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Affiliation(s)
- E Maraví-Poma
- UCI-B, Complejo Hospitalario de Navarra (antiguo Hospital Virgen del Camino), Pamplona, España.
| | - E Patchen Dellinger
- Department of Surgery, University of Washington School of Medicine, Seattle, Estados Unidos
| | - C E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, Estados Unidos
| | - P Layer
- Department of Internal Medicine, Israelitic Hospital, Hamburgo, Alemania
| | - P Lévy
- Pôle des Maladies de l'Appareil Digestif, Service de Gastroenterologie-Pancreatologie, Hopital Beaujon, Clichy, Francia
| | - T Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japón
| | - A K Siriwardena
- Department of Surgery, Manchester Royal Infirmary, University of Manchester, Manchester, Reino Unido
| | - G Uomo
- Department of Internal Medicine, Cardarelli Hospital, Nápoles, Italia
| | - D C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Department of Cell Biology and Molecular Physiology, Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, Estados Unidos
| | - J A Windsor
- Department of Surgery, University of Auckland, Miembro International Association of Pancreatology, Auckland, Nueva Zelanda
| | - M S Petrov
- Department of Surgery, University of Auckland, Miembro International Association of Pancreatology, Auckland, Nueva Zelanda
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Wu BU, Banks PA. Clinical management of patients with acute pancreatitis. Gastroenterology 2013; 144:1272-81. [PMID: 23622137 DOI: 10.1053/j.gastro.2013.01.075] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/31/2012] [Accepted: 01/07/2013] [Indexed: 12/14/2022]
Abstract
Acute pancreatitis is the leading cause of hospitalization for gastrointestinal disorders in the United States. As rates of hospitalization for acute pancreatitis continue to increase, so does demand for effective management. We review approaches to best manage patients with acute pancreatitis, covering diagnosis, risk and prognostic factors, treatment, and complications, considering recommendations from current practice guidelines.
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Affiliation(s)
- Bechien U Wu
- Center for Pancreatic Care, Southern California Permanente Medical Group, Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
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Determinant-based classification of acute pancreatitis severity: an international multidisciplinary consultation. Ann Surg 2013; 256:875-80. [PMID: 22735715 DOI: 10.1097/sla.0b013e318256f778] [Citation(s) in RCA: 321] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. BACKGROUND The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity. METHODS A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis. The invitation was not limited to members of certain associations or residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. RESULT The new international classification is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity. The local determinant relates to whether there is (peri)pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent. The presence of one determinant can modify the effect of another such that the presence of both infected (peri)pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone. The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical. CONCLUSIONS This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
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Current world literature. Curr Opin Organ Transplant 2013; 18:111-30. [PMID: 23299306 DOI: 10.1097/mot.0b013e32835daf68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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