Accuracy of contrast-enhanced ultrasound compared with conventional ultrasound in acute pancreatitis: Diagnosis and complication monitoring

Transabdominal ultrasound for the diagnostic workup of parenchymal pancreatic diseases

This continuing medical education article highlights the central role of transcutaneous sonography in diagnosing parenchymal pancreatic diseases. It emphasizes the importance of in-depth knowledge of sonographic imaging of organ anatomy and a structured examination methodology, particularly for identifying acute and chronic pancreatitis and related complications. The article provides detailed guidance for optimized examination techniques and equipment settings, even under challenging conditions, and discusses the application of ultrasound in various scenarios of pancreatic diseases. Moreover, the relevance of advanced sonographic techniques such as high-frequency sonography, elastography, and contrast-enhanced sonography is illuminated in the context of expanded diagnostic workup.

[Direct transfistulous ultrasound in minimally invasive surgical treatment of infected pancreatic necrosis]

OBJECTIVE

To develop a method for direct transfistulous ultrasound in minimally invasive treatment of infected pancreatic necrosis.

MATERIAL AND METHODS

There were 148 patients with infected pancreatic necrosis between 2015 and 2019 at the Krasnodar City Clinical Hospital No. 2. Drainage with 28-32 Fr tubes was carried out at the first stage, endoscopic transfistulous sequestrectomy - at the second stage (19 (12.8%) patients). In 84 (56.8%) patients, we applied original diagnostic method (transfistulous ultrasonic assessment of inflammatory focus).

RESULTS

There were 3 accesses to omental bursa in 93 (62.8%) patients and 2 in 43 (29.1%) patients. We also performed 2 access to retroperitoneal space in 63 (42.6%) patients and 1 access in 38 (25.8%) cases. Transfistulous ultrasound was used once in 19 (22.6%) patients, twice in 28 (33.3%) and 3 times in 37 (44.1%) patients. Examination was not performed in 18 (12.2%) patients due to the following reasons: migration of drainage catheters - 5, non-rectilinear fistulous tract - 13. No complications were observed.

CONCLUSION

Transfistulous ultrasound makes it possible to diagnose pathological changes in the pancreas and parapancreatic tissue at various stages of surgical treatment.

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

Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use. Despite the central role of imaging technologies and scoring systems in AP management, these methods have limitations in terms of accuracy, reproducibility, practicality and economics. Recent advancements of artificial intelligence (AI) provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data. AI algorithms can analyze large amounts of clinical and imaging data, identify scoring system patterns, and predict the clinical course of disease. AI-based models have shown promising results in predicting the severity and mortality of AP, but further validation and standardization are required before widespread clinical application. In addition, understanding the correlation between these three technologies will aid in developing new methods that can accurately, sensitively, and specifically be used in the diagnosis, severity prediction, and prognosis assessment of AP through complementary advantages.

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 diagnostics in acute pancreatitis]

Abdominal imaging is an important component of the diagnostics of acute pancreatitis. In addition to the clinical features and the laboratory constellation, it serves to establish the diagnosis or the exclusion of other diseases and also the identification and assessment of the course of local complications and vascular changes that can arise during the course of acute pancreatitis. Due to the numerous imaging examination methods that are available, their combination options and the different examination times, there are diverse application options that have to be taken into account, such as the severity and duration of the disease, concomitant diseases and complications of acute pancreatitis. A rational use of imaging is an important prerequisite for high quality and at the same time cost-effective patient care. This review summarizes the current importance of imaging in acute pancreatitis, with particular reference to the updated S3 guidelines on acute pancreatitis.

Pancreatic Evaluation in Dogs using Different Ultrasonographic Techniques – Preliminary Results

The aim of this study is to describe the preliminary results on the accuracy of ultrasonographic techniques such as elastography, contrast enhanced ultrasound (CEUS) and Doppler in determining pancreatic changes. Twenty-five dogs, males and females, aged 1-14 years, were studied. Sixteen animals had no clinical signs of pancreatic disease (GS) and nine presented signs of pancreatic disorders (GD). All animals from GD presented sonographic changes in B-mode and qualitative elastography, with shear-wave velocity (SWV) higher (2.4±0.5m/s) in GD (p=0.014) than GS (1.9±0.3m/s) resulting in 78% sensitivity and 69% specificity in the identification of pancreatic changes. Regarding Doppler mode, no differences were observed between groups with color mapping or pulsed wave Doppler. The values obtained with CEUS did not differ between groups. Elastography is a promising technique for differential diagnosis of pancreatic changes because of its sensitivity and specificity, while the other techniques did not show diagnostic accuracy.

Differential diagnosis of solid pancreatic masses

Solid pancreatic lesions include mainly adenocarcinoma, neuroendocrine tumors pancreatic cystic neoplasms with solid component, solid pseudopapillary tumor, pancreatoblastoma, pancreatic lymphoma, and pancreatic metastasis. The most frequent pancreatic lesion is the adenocarcinoma, representing between 70% and 95% of all solid pancreatic neoplasm. The diagnosis of these lesions can be a challenge and currently, there are different imaging techniques such as CT scan, EUS and MRI with high sensitivity and specificity. The most widely used technique for the initial evaluation is the CT scan with a sensitivity between 76% and 92% for the diagnosis of pancreatic cancer. The EUS has a sensitivity for the detection of pancreatic lesions of around 98% and is accepted to be the most sensitive technique for the detection of small pancreatic tumors (<2 cm). The MRI, with a very high soft-tissue contrast resolution, provides an accuracy in the detection and staging of adenocarcinoma of 90-100%. A multimodality approach is usually necessary in patients with clinical suspicion of pancreatic lesion. The EUS is required for the local evaluation of the relation of the lesion with vessels and for tissue acquisition and the CT scan and/or MRI is usually required for the local and distance staging in case of pancreatic cancer. The purpose of this review is to provide an overview of solid pancreatic lesions and the role of the different imaging techniques in their evaluation.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

Acute pancreatitis (AP) is a severe inflammation of the pancreas presented with sudden onset and severe abdominal pain with a high morbidity and mortality rate, if accompanied by severe local and systemic complications. Numerous studies have been published about the pathogenesis of AP; however, the precise mechanism behind this pathology remains unclear. Extensive research conducted over the last decades has demonstrated that the first 24 h after symptom onset are critical for the identification of patients who are at risk of developing complications or death. The identification of these subgroups of patients is crucial in order to start an aggressive approach to prevent mortality. In this sense and to avoid unnecessary overtreatment, thereby reducing the financial implications, the proper identification of mild disease is also important and necessary. A large number of multifactorial scoring systems and biochemical markers are described to predict the severity. Despite recent progress in understanding the pathophysiology of AP, more research is needed to enable a faster and more accurate prediction of severe AP. This review provides an overview of the available multifactorial scoring systems and biochemical markers for predicting severe AP with a special focus on their advantages and limitations.

Effectiveness of contrast-enhanced ultrasound for the diagnosis of acute pancreatitis: A systematic review and meta-analysis

OBJECTIVE

To systematically determine the diagnostic value of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis.

METHODS

Relevant studies were identified by searching the database up to December 2016. Patient clinical characteristics and diagnostic sensitivity and specificity were extracted. The summary receiver operating characteristic (ROC) curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in the diagnosis and evaluation of acute pancreatitis.

RESULTS

From 27 citations, seven were included in the meta-analysis, with a total of 421 cases. We detected the heterogeneity of the studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.92 (95% CI: 0.88, 0.95), the specificity was 0.84 (95% CI: 0.78, 0.90), the positive likelihood ratio was 5.38 (95% CI: 3.21, 9.00), the negative likelihood ratio was 0.13 (95% CI: 0.05, 0.36), and the diagnostic odds ratio was 49.37 (95% CI: 14.69, 165.94). The area under the ROC curve was 0.9273 (95% CI: 0.8916, 0.9790).

CONCLUSIONS

CEUS is a reliable, non-invasive imaging modality with no radiation exposure and a high sensitivity and specificity for the assessment of severity of acute pancreatitis. Nonetheless, it should be applied cautiously, and large-scale, well-designed trials are necessary to assess its clinical value.