Radiology of acute pancreatitis today: the Atlanta classification and the current role of imaging in its diagnosis and treatment

Decreased HDL-C Levels as a Predictor of Organ Failure in Acute Pancreatitis in the Emergency Department

High-density lipoprotein cholesterol (HDL-C) is reported as a biomarker of systemic inflammation and multi-organ failure (MOF), which has been rarely investigated in acute pancreatitis (AP), a frequent condition in the emergency department (ED). The objective was to study the predictive capacity of the decrease in HDL-C to the progression of MOF in AP in the ED; analyzing 114 patients with AP for one year in a longitudinal and prospective study, AP severity was obtained by the Atlanta classification, in relation to modified Marshall and Bedside Index for Severity in Acute Pancreatitis (BISAP) scores, and clinical and laboratory parameters in a 48 h hospital stay. The area under the receiver operating characteristic (ROC) curve was used to estimate the validity of the predictor and define optimal cut-off points. It was found that AP was classified as severe in 24.5%, mainly for biliary etiology (78.9%) and female sex (73.6%). As a biomarker, HDL-C decreased from 31.6 to 29.5 mg/dL in a 48 h stay (p < 0.001), correlating negatively with the increase in severity index > 2 and the modified Marshall (p < 0.032) and BISAP (p < 0.009) scores, finding an area under the ROC curve with a predictive capacity of 0.756 (95% CI, 0.614-0.898; p < 0.004) and a cut-off point of 28.5 mg/dL (sensitivity: 79%, specificity: 78%), demonstrating that the decrease in HDL-C levels serves as a useful indicator with a predictive capacity for MOF in mild to severe AP, during a 48 h hospital stay in the ED.

Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period

AIMS

To determine time trends in the incidence and etiology of acute pancreatitis and identify predictors for in-hospital mortality.

PATIENTS AND METHODS

Retrospective study of 1722 patients with acute pancreatitis admitted to Akershus University Hospital between January 2000 and December 2017. Data were obtained from electronic patient files and computed tomography scans. We estimated a logistic regression model to assess differences in associations between patient characteristics and in-hospital mortality in two time periods, 2000-2009 (first period) and 2010-2018 (second period).

RESULTS

First attack of acute pancreatitis (FAAP) was identified in 1579 patients (91.7%). The incidence of FAAP increased from 20.1/100,000 during the first period to 27.7/100,000 in the second period (p = .011). Etiology showed no differences between the two time periods. Gallstone was the most frequent etiology (47.2%). In total, 187 patients (11.8%) had necrotizing pancreatitis; more in the second period compared to the first (14.2 vs. 7.7%; p < .001). The overall mortality rate was 3.9%. Mortality rates decreased for both inflammatory and necrotizing pancreatitis during the study period. Age and comorbidity according to Charlson Comorbidity Index (CCI) were predictors of in-hospital mortality (OR 1.07, 95% CI 0.07; 0.40 and 13.58, 95% CI 3.88; 47.52), as were alcohol and organ failure (OR 7.20, 95% CI 2.02; 25.67 and OR 34.15, 95% CI 8.94; 130.53, respectively).

CONCLUSIONS

The incidence of FAAP is increasing in southeast Norway. The etiology has remained unchanged over an 18-year period, with gallstones being the most frequent cause. The outcomes for both inflammatory and necrotic pancreatitis are improving.

Acute pancreatitis: Structured report template of magnetic resonance imaging

Acute pancreatitis (AP) is a common acute abdomen disease of the digestive system. It has a potentially fatal risk because of its variable severity and various complications. With the widespread application of the Revised Atlanta Classification, new requirements for AP imaging reports are introduced. Experts in abdominal radiology and pancreatology in the United States published the first structured computed tomography reporting template for AP in 2020. However, there is no corresponding structured magnetic resonance imaging (MRI) reporting template globally. Therefore, this article focuses on the structured MRI report of AP images from our pancreatitis imaging center, which is intended to improve the systematic understanding of this disease and standardize the writing of MRI structured reports. In the meantime, we aim to promote the clinical diagnosis and assessment of MRI efficacy for AP and its multiple complications. It is further intended to facilitate academic exchanges and scientific research between different medical centers.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Imaging acute pancreatitis

OBJECTIVES

Acute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them.

CONCLUSIONS

Imaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.