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Lee DW, Cho CM. Predicting Severity of Acute Pancreatitis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060787. [PMID: 35744050 PMCID: PMC9227091 DOI: 10.3390/medicina58060787] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Acute pancreatitis has a diverse etiology and natural history, and some patients have severe complications with a high risk of mortality. The prediction of the severity of acute pancreatitis should be achieved by a careful ongoing clinical assessment coupled with the use of a multiple-factor scoring system and imaging studies. Over the past 40 years, various scoring systems have been suggested to predict the severity of acute pancreatitis. However, there is no definite and ideal scoring system with a high sensitivity and specificity. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Although contrast-enhanced computed tomography (CT) is considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 h of presentation. This article provides an overview of the available scoring systems and biochemical markers for predicting severe acute pancreatitis, with a focus on their characteristics and limitations.
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Hosokawa T, Tanami Y, Sato Y, Oguma E. Comparison of the Balthazar score of acute pancreatitis between computed tomography and ultrasound in children: pitfalls of ultrasound in diagnosing and evaluating pancreatitis. J Med Ultrason (2001) 2021; 48:605-613. [PMID: 34309755 DOI: 10.1007/s10396-021-01117-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To demonstrate the utility of ultrasound for predicting the outcome of pancreatitis in pediatric patients using the Balthazar score. METHODS Twenty-four children diagnosed with pancreatitis, who underwent computed tomography (CT) followed by ultrasound within 24 h, were included. The Balthazar score was calculated using both modalities based on the appearance of the pancreas (score 0-4). The association between the Balthazar scores with CT and ultrasound was evaluated using single linear regression analysis. To evaluate the sonographic accuracy, the ultrasound severity index and findings were compared with those of CT. Presence or absence of abnormal pancreatic parenchymal change on ultrasound was compared to the presence or absence of pancreatic necrosis on CT. The CT and sonographic findings were evaluated in eight intra-abdominal segments. RESULTS The Balthazar scores yielded by CT (2.2 ± 1.1, range 0-4) and ultrasound (2.0 ± 1.1, range 0-4) showed a significantly strong correlation (r = 0.918, p < 0.001). The accuracy of ultrasound in determining the CT Balthazar scores was 91.7% (95% confidence interval 73.0-99.0%, 22/24 patients). In the two cases with pancreatic necrosis on CT, only one case was detected as abnormal pancreatic parenchymal change. Sonographic diagnostic accuracy in the pancreatic head was lower than that in the body and tail (accuracy of the pancreatic head, body, and tail enlargement/edema = 83.3%/75%, 100%/100%, and 100%/100%, respectively). CONCLUSIONS The total CT and ultrasound severity indices were significantly correlated. Ultrasound is a useful modality for evaluating not only the initial pancreatic condition but also the severity of pediatric pancreatitis.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Saitama, 330-8777, Japan.
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Saitama, 330-8777, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Saitama, 330-8777, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama, Saitama, 330-8777, Japan
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Silva-Vaz P, Abrantes AM, Castelo-Branco M, Gouveia A, Botelho MF, Tralhão JG. Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice. Int J Mol Sci 2020; 21:E338. [PMID: 31947993 PMCID: PMC6982212 DOI: 10.3390/ijms21010338] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Pedro Silva-Vaz
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Ana Margarida Abrantes
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - António Gouveia
- General Surgery Department, Hospital Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal;
- Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Maria Filomena Botelho
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
| | - José Guilherme Tralhão
- Coimbra Institute for Clinical and Biomedical Research (iCBR) area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (A.M.A.); (M.F.B.); (J.G.T.)
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics and Biomathematics Institute, IBILI-Faculty of Medicine of University of Coimbra, 3000-348 Coimbra, Portugal
- Surgery Department, Centro Hospitalar e Universitário de Coimbra (CHUC), University Hospital, Faculty of Medicine, 3000-075 Coimbra, Portugal
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Effectiveness of contrast-enhanced ultrasound for the diagnosis of acute pancreatitis: A systematic review and meta-analysis. Dig Liver Dis 2017; 49:623-629. [PMID: 28462883 DOI: 10.1016/j.dld.2017.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/22/2017] [Accepted: 03/25/2017] [Indexed: 12/11/2022]
Abstract
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.
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Cai D, Parajuly SS, Wang H, Wang X, Ling W, Song B, Li Y, Luo Y. Accuracy of contrast-enhanced ultrasound compared with conventional ultrasound in acute pancreatitis: Diagnosis and complication monitoring. Exp Ther Med 2016; 12:3189-3194. [PMID: 27882136 PMCID: PMC5103763 DOI: 10.3892/etm.2016.3760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/01/2016] [Indexed: 02/05/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) has been used for diagnosing acute pancreatitis (AP), particularly severe acute pancreatitis (SAP). However, the diagnostic difference between CEUS and conventional ultrasonography (CUS) for AP and SAP has not been reported. The aim of the present study was to investigate the diagnostic accuracy of CUS and CEUS for AP. A total of 196 patients clinically diagnosed with AP were selected. All patients underwent CUS, CEUS and contrast-enhanced computed tomography (CECT) within 72 h. CECT was considered the gold standard. Pancreatic size, peripancreatic fluid collection (PPFC) and splenic vessel complications were the variables observed by CUS and CEUS. The differences in the variables among the three methods were analyzed using the χ2 test and statistical analysis software. Significant differences in pancreatic size, PPFC and splenic vessel complications in AP were observed between CEUS and CUS (P<0.05). χ2 test results indicated that CEUS significantly differed from CUS in terms of having a higher diagnostic accuracy for AP and SAP (P<0.05). The results indicate that CEUS is a reliable method for the diagnosis and monitoring of AP and SAP, and may be substituted for CECT.
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Affiliation(s)
- Diming Cai
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shyam Sundar Parajuly
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Huiyao Wang
- Training Department of Resident Doctor, West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaoling Wang
- Department of Operations Management, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yongzhong Li
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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D'Onofrio M, Canestrini S, De Robertis R, Crosara S, Demozzi E, Ciaravino V, Pozzi Mucelli R. CEUS of the pancreas: Still research or the standard of care. Eur J Radiol 2015; 84:1644-9. [PMID: 25796427 DOI: 10.1016/j.ejrad.2015.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/23/2015] [Accepted: 02/25/2015] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced ultrasonography (CEUS) improves the characterization of pancreatic masses. CEUS is in fact a safe and accurate imaging method to evaluate the vascularity of pancreatic lesions. CEUS should be performed when possible immediately after the ultrasound (US) detection of a pancreatic mass. CEUS is accurate in the characterization of ductal adenocarcinoma. The use of CEUS in studying pancreatic lesions found at US, especially in the same session of ultrasound examination, is therefore recommendable to promote faster diagnosis mainly of pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
| | - Stefano Canestrini
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Riccardo De Robertis
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Stefano Crosara
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Emanuele Demozzi
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Valentina Ciaravino
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Roberto Pozzi Mucelli
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
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Rademacher N, Schur D, Gaschen F, Kearney M, Gaschen L. CONTRAST-ENHANCED ULTRASONOGRAPHY OF THE PANCREAS IN HEALTHY DOGS AND IN DOGS WITH ACUTE PANCREATITIS. Vet Radiol Ultrasound 2015; 57:58-64. [PMID: 26332486 DOI: 10.1111/vru.12285] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 12/14/2022] Open
Abstract
Pancreatitis is the most frequent disease affecting the exocrine pancreas in dogs and reliable diagnostic techniques for predicting fatal complications are lacking. Contrast-enhanced ultrasound (CEUS) improves detection of tissue perfusion as well as organ lesion vascular pattern. Objectives of this prospective case control study were to compare perfusion characteristics and enhancement patterns of the pancreas in healthy dogs and dogs with pancreatitis using CEUS. Ten healthy dogs and eight dogs with pancreatitis were selected based on physical examination, abdominal ultrasound, and blood analysis findings. A CEUS study of the pancreas was performed for each dog and two observers who were aware of clinical status used advanced ultrasound quantification software to analyze time-intensity curves. Perfusion patterns were compared between healthy and affected dogs. In dogs with acute pancreatitis, mean pixel and peak intensity of the pancreatic parenchyma was significantly higher than that of normal dogs (P = 0.05) in between 6 and 60 s (P = <0.0001-0.046). This corresponds to a 311% increase in mean pixel intensity in dogs with acute pancreatitis compared to healthy dogs. Wash-in rates were greater and had a consistently steeper slope to peak in dogs with pancreatitis as opposed to healthy dogs. All dogs with pancreatitis showed a decrease in pixel intensity 10-15 days after the initial examination (P = 0.011) and their times to peak values were prolonged compared to the initial exam. Findings from the current study supported the use of CEUS for diagnosing pancreatitis, pancreatic necrosis, and disease monitoring following therapy in dogs.
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Affiliation(s)
- Nathalie Rademacher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - David Schur
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Frédéric Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Michael Kearney
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
| | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, 70803
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Lim S, Nakamura K, Morishita K, Sasaki N, Murakami M, Osuga T, Ohta H, Yamasaki M, Takiguchi M. Qualitative and quantitative contrast-enhanced ultrasonographic assessment of cerulein-induced acute pancreatitis in dogs. J Vet Intern Med 2014; 28:496-503. [PMID: 24612403 PMCID: PMC4858020 DOI: 10.1111/jvim.12319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/11/2013] [Accepted: 01/07/2014] [Indexed: 12/14/2022] Open
Abstract
Background Acute pancreatitis (AP) is the most common disease of the canine exocrine pancreas, and accurate noninvasive diagnosis is challenging. Hypothesis/Objectives To determine the feasibility of using quantitative contrast‐enhanced ultrasonography (CEUS) to detect pancreatic perfusional changes in cerulein‐induced AP in dogs. Animals Six adult female Beagles. Methods Each dog received 2 hours of IV infusion with 7.5 μg/kg/h of cerulein diluted in saline. As control, all dogs received 2 hours of IV infusion of saline 2 weeks before cerulein infusion. CEUS of the pancreas and duodenum were performed before (0 hour), and at 2, 4, 6, and 12 hours after saline and cerulein infusion. Time‐intensity curves were created from regions of interest in the pancreas and duodenum. Five perfusional parameters were measured for statistical analysis: time to initial up‐slope, peak time, time to wash‐out, peak intensity (PI), and area under the curve (AUC). Results In cerulein‐induced AP, pancreatic PI increased at 2 and 4 hours when compared to 0 hour, and at 2, 4, and 6 hours when compared to control. AUC increased at 4 hours when compared to 0 hour, and at 2 and 4 hours when compared to control. Time to wash‐out was prolonged at 4 hours when compared to control. For saline control, peak time was faster at 2 hours when compared to 0 hour. Conclusions and Clinical Importance CEUS parameters PI and AUC can provide useful information in differentiating acute pancreatitis from normal pancreas. Cerulein‐induced AP was characterized by prolonged hyperechoic enhancement on CEUS.
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Affiliation(s)
- S.Y. Lim
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - K. Nakamura
- Hokkaido University Veterinary Teaching HospitalGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - K. Morishita
- Hokkaido University Veterinary Teaching HospitalGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - N. Sasaki
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - M. Murakami
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - T. Osuga
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - H. Ohta
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - M. Yamasaki
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
| | - M. Takiguchi
- Laboratory of Veterinary Internal MedicineGraduate School of Veterinary MedicineHokkaido UniversityHokkaidoJapan
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Cai DM, Parajuly SS, Ling WW, Li YZ, Luo Y. Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis. World J Gastroenterol 2014; 20:1088-1094. [PMID: 24574783 PMCID: PMC3921534 DOI: 10.3748/wjg.v20.i4.1088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the value of contrast-enhanced ultrasound (CEUS) in diagnosing splenic artery complications (SACs) after acute pancreatitis (AP). METHODS One hundred and eighteen patients with AP were enrolled in the study. All patients were examined by CEUS and contrast-enhanced computed tomography (CECT). CECT was accepted as a gold standard for the diagnosis of SACs in AP. The diagnostic accuracy of splenic CEUS and pancreatic CEUS was compared with that of CECT. Splenic infarction was the diagnostic criterion for splenic artery embolism and local dysperfusion of the splenic parenchyma was the diagnostic criterion for splenic arterial stenosis. The incidence of splenic sub-capsular hemorrhage, splenic artery aneurysms, and splenic rupture was all lower than that of SACs. RESULTS Nine patients were diagnosed as having SACs after AP by CECT among the 118 patients. The patients with SACs were diagnosed with severe acute pancreatitis (SAP). Among them, 6 lesions were diagnosed as splenic artery embolism, 5 as splenic artery aneurysms, and 1 as splenic arterial stenosis. No lesion was diagnosed by pancreatic CEUS and 5 lesions were diagnosed by splenic CEUS. By splenic CEUS, 4 cases were diagnosed as splenic artery embolism and 1 as splenic arterial stenosis. The accuracy of splenic CEUS in diagnosis of SACs in SAP was 41.7% (5/12), which was higher than that of pancreatic CEUS (0%). CONCLUSION Splenic CEUS is a supplementary method for pancreatic CEUS in AP patients, which can decrease missed diagnosis of SACs.
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Zerem E, Imamović G, Latić F, Mavija Z. Prognostic value of acute fluid collections diagnosed by ultrasound in the early assessment of severity of acute pancreatitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:203-209. [PMID: 22987623 DOI: 10.1002/jcu.21995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/13/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To evaluate the prognostic value of acute fluid collections (AFC) diagnosed by conventional transabdominal ultrasound in the early assessment of severity acute pancreatitis (AP). METHODS We studied 128 consecutive patients with AP between March 2006 and March 2011. The predictor was the number of AFC. Outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced CT, and pancreatitis-specific clinical and laboratory findings were performed. RESULTS AFC were associated with complications (p < 0.0001), Balthazar grade (p = 0.004), Ranson score (p < 0.0001), and the majority of clinical, radiologic, and biochemical parameters for predicting complications of AP (p < 0.05). Univariate logistic regression also revealed significant association between the number of AFC and the occurrence of complications (OR 4.4; 95% CI 2.5-7.6). After the adjustment for covariates, AFC remained prognostic for complications and a cutoff point of >1 AFC was prognostic of their occurrence with 88% sensitivity and 82% specificity. CONCLUSIONS AFC are related to the clinical course of AP and can predict its severity
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Affiliation(s)
- Enver Zerem
- Department of Gastroenterology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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11
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Cai DM, Li YZ, Ma BY, Ling WW, Jiang Y, Zhang LY, Zhong XF, Zhang JY, Song B. Diagnostic value of ultrasound in detection of solid pseudopapillary tumor of the pancreas. Shijie Huaren Xiaohua Zazhi 2013; 21:1803. [DOI: 10.11569/wcjd.v21.i19.1803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Andersen AM, Malmstrøm ML, Novovic S, Nissen FH, Jensen LI, Holm O, Hansen MB. Contrast enhanced ultrasonography in acute pancreatitis. Pancreatology 2012; 13:95-7. [PMID: 23395577 DOI: 10.1016/j.pan.2012.12.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 12/11/2012] [Accepted: 12/15/2012] [Indexed: 12/11/2022]
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13
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[Gastrointestinal emergencies - acute pancreatitis]. Med Klin Intensivmed Notfmed 2012; 108:491-6. [PMID: 23076392 DOI: 10.1007/s00063-012-0154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/11/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
Abstract
The acute pancreatitis is a frequent event with an impressive clinical presentation. Specific treatment does not exist. The goals of the medical measures are to ameliorate complaints and to prevent complications. During recent years, insights into adequate treatment have significantly increased. Recommendations on volume therapy have now been specified. Moreover, progress has been made in the efficient employment of nutritional support, imaging and antibiotic treatment. In addition, the treatment of large or infected necrosis has significantly improved. The article reviews the current state-of-the-art care of acute pancreatitis.
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Abstract
The administration of a contrast agent is considered an essential tool to evaluate abdominal diseases using Ultrasound. The most targeted organ is the liver, especially to characterize focal liver lesions and to assess the response to percutaneous treatment. However, the expanding abdominal indications of contrast-enhanced ultrasound make this technique an important tool in the assessment of organ perfusion including the evaluation of ischemic, traumatic, and inflammatory diseases.
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Affiliation(s)
- Carlos Nicolau
- Radiology Department, Hospital Clínic, University of Barcelona, Spain.
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15
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Johnson-Neitman JL, O'Brien RT, Wallace JD. Quantitative perfusion analysis of the pancreas and duodenum in healthy dogs by use of contrast-enhanced ultrasonography. Am J Vet Res 2012; 73:385-92. [DOI: 10.2460/ajvr.73.3.385] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lu Q, Zhong Y, Wen XR, Huang ZW, Fan YT, Xia Q, Luo Y. Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis? Dig Dis Sci 2011; 56:1578-1584. [PMID: 21113802 DOI: 10.1007/s10620-010-1460-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/06/2010] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the ability of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis (AP), as well as its diagnostic accuracy in the evaluation of the severity of pancreatitis. METHODS A prospective double-blind study was carried out in 33 AP patients from May 2007 to January 2008. Each patient underwent both CEUS and contrast-enhanced computed tomography (CECT) with the time interval between two examinations less than 72 h. Using CECT as gold standard, the ability of CEUS to diagnose pancreatic necrosis as well as peripancreatic effusion and/or complications, and its diagnostic value in the evaluation of the severity of pancreatitis, were investigated. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI), and the correlation between CTSI and USSI was tested by Spearman's rank correlation coefficient. RESULTS A strong correlation between CTSI and USSI was found (r = 0.92, P < 0.01).The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS in the diagnosis of pancreatic parenchyma necrosis were 90, 95, 94, 90 and 95%, in the diagnosis of peripancreatic effusion and/or complications were 83, 100, 93, 100 and 91%, and in the diagnosis of severe pancreatitis were 97, 67, 94, 97 and 67%, respectively. CONCLUSIONS CEUS has shown to be of clinical value in the assessment of pancreatic necrosis as well as peripancreatic complications in AP and has a high diagnostic accuracy in the evaluation of the severity of pancreatitis. Further studies are needed to add it to the diagnostic algorithm for acute pancreatitis.
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Affiliation(s)
- Qiang Lu
- Department of Sonography, West China Hospital, Sichuan University, 610041, Chengdu, China
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17
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Hijioka S, Sawaki A, Mizuno N, Hara K, Mekky MA, El-Amin H, El-Abdeen Ahmed Sayed Z, Tajika M, Niwa Y, Yamao K. Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings in adrenal metastasis from renal cell carcinoma. J Med Ultrason (2001) 2011; 38:89-92. [PMID: 21836820 PMCID: PMC3150819 DOI: 10.1007/s10396-010-0297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/26/2010] [Indexed: 01/30/2023]
Abstract
Solitary adrenal metastasis is often difficult to distinguish from benign adrenal tumor using only plain computed tomography (CT) scanning. We describe a solitary left adrenal gland mass in a patient who had undergone simultaneous gastrectomy and right nephrectomy for advanced gastric cancer and renal cell carcinoma (RCC), respectively. Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings indicated a hypervascular adrenal mass, and EUS-guided fine needle aspiration (EUS-FNA) revealed clear cell carcinoma. Adrenalectomy confirmed metastatic clear cell carcinoma of the kidney.
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Contrast-enhanced ultrasound in the staging of acute pancreatitis. Eur Radiol 2010; 20:2518-23. [PMID: 20532782 DOI: 10.1007/s00330-010-1824-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/05/2010] [Accepted: 05/10/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine the diagnostic value of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis, with computed tomography (CT) as the reference standard. METHODS Fifty consecutive patients (mean age 58.4 years; range 23-86 years) with acute pancreatitis underwent prospectively both CT and ultrasonography, including CEUS, within a 24-h interval. Pancreatic vascularisation was evaluated with CEUS after injection of a second-generation US contrast-enhancing agent. Acute pancreatitis severity was graded according to the Balthazar index. The results were compared with CT severity index and clinical outcome by using Spearman's correlation coefficient. RESULTS A significant correlation between CT and CEUS was found for the CT severity index (r = 0.926), extent of necrosis (r = 0.893) and Balthazar grade (r = 0.884). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting severe acute pancreatitis based on CT findings (severity index greater than 3 and/or presence of necrosis) were respectively 91%, 100%, 100% and 83%. A significant correlation between CEUS severity index and clinical variables was found: Ranson score (r = 0.442), C-reactive protein (CRP) levels 48 h after admission (r = 0.385) and length of hospital stay (r = 0.362). CONCLUSION CEUS is comparable to CT in detecting pancreatic necrosis as well as predicting its clinical course. Therefore, when CT is contraindicated CEUS may be a valid alternative.
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Imazu H, Uchiyama Y, Matsunaga K, Ikeda KI, Kakutani H, Sasaki Y, Sumiyama K, Ang TL, Omar S, Tajiri H. Contrast-enhanced harmonic EUS with novel ultrasonographic contrast (Sonazoid) in the preoperative T-staging for pancreaticobiliary malignancies. Scand J Gastroenterol 2010; 45:732-8. [PMID: 20205504 DOI: 10.3109/00365521003690269] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Sonazoid is a new second-generation microbubble contrast for ultrasonography. In this pilot study, the diagnostic role of contrast-enhanced harmonic imaging endoscopic ultrasonography (CH-EUS) with Sonazoid was prospectively evaluated in preoperative T-staging of pancreaticobiliary malignancies. PATIENTS AND METHODS Patients with suspected pancreaticobiliary malignancies underwent CH-EUS by a single examiner. After the lesions were observed carefully with conventional harmonic imaging EUS (H-EUS), CH-EUS was performed with intravenous injection of Sonazoid. A reviewer who was blinded reviewed the recordings of H-EUS and CH-EUS and assessed the T-staging. The accuracy of H-EUS and CH-EUS for T-staging was compared to the results of surgical histopathology in patients who underwent surgery. RESULT Twenty-six patients underwent surgical resection and could be included in the study. The final diagnosis were pancreatic cancer in 11, bile duct cancer in 7, gallbladder cancer in 4 and ampullary cancer in 4. The overall accuracy of H-EUS and CH-EUS for T-staging were 69.2 (18/26) and 92.4% (24/26), respectively (p < 0.05). There were disagreement in six cases between H-EUS and CH-EUS. CH-EUS staged correctly in all of these six cases, whereas H-EUS misdiagnosed the depth of invasion in one case of gallbladder cancer and one case of ampullary cancer, and invasion of portal vein in two cases of pancreatic cancer and two cases of bile duct cancer. CONCLUSION The depth of invasion of biliary cancer and vascular invasion of pancreatic and biliary cancer could be demonstrated more clearly with CH-EUS compared to H-EUS. CH-EUS has the potential to improve the diagnostic accuracy of preoperative T-staging of pancreaticobiliary malignancies.
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Affiliation(s)
- Hiroo Imazu
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
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20
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Neye H, Ensberg D, Rauh P, Peitz U, Mönkemüller K, Treiber G, Klauck S, Malfertheiner P, Rickes S. Impact of high-resolution transabdominal ultrasound in the diagnosis of complications of Crohn's disease. Scand J Gastroenterol 2010; 45:690-5. [PMID: 20235899 DOI: 10.3109/00365521003710190] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Crohn's disease is associated with intestinal complications such as strictures, fistulas and abscesses. As the management of the patients is influenced by the presence or absence of complication, sensitive diagnostic modalities to detect these complications are needed. The aim of this prospective study was to evaluate the diagnostic accuracy of high-resolution transabdominal ultrasound in the diagnosis of complications of Crohn's disease. MATERIAL AND METHODS From April 2003 to July 2009, 58 patients (31 women, 27 men; mean age 36.3 years, range 13-86 years) with known Crohn's disease were included in the study and investigated with high-resolution transabdominal ultrasound. The diagnosis of Crohn's disease was based on clinical, endoscopic, histological, radiological and operative findings. Patients with other forms of enteritis (e.g. infectious) were excluded from the study. Twenty of the 58 patients were investigated on a second occasion with other symptoms than at the first admission. The time duration between the two ultrasound investigations was at least 3 months. Consequently, a total of 78 ultrasound investigations were done in 58 patients. With respect to their clinical symptoms, all patients were further investigated within 2 weeks after ultrasound with magnetic resonance imaging, and/or computed tomography, and/or enteroclysis, and/or endoscopy with biopsy. Together with clinical data (Crohn's disease activity index) and surgical findings these investigations were used as reference procedure. RESULTS The sensitivity, specificity, positive predictive and negative predictive values of ultrasound were as follows: 0.86, 0.90, 0.83 and 0.92 for stenoses; 0.78, 0.95, 0.86, and 0.91 for fistulas; 0.90, 0.99, 0.90 and 0.99 for abscesses, respectively. CONCLUSIONS High-resolution transabdominal ultrasound done by experienced examiners has an excellent diagnostic accuracy in the diagnosis of complications in patients with Crohn's disease. Thus, it can be recommended as one of the primary investigative procedures for evaluation of Crohn's disease.
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Affiliation(s)
- Holger Neye
- Department of Internal Medicine, AMEOS Hospital St. Salvator, Halberstadt, Germany
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21
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Sakamoto H, Kitano M, Kamata K, El-Masry M, Kudo M. Diagnosis of pancreatic tumors by endoscopic ultrasonography. World J Radiol 2010; 2:122-34. [PMID: 21160578 PMCID: PMC2999320 DOI: 10.4329/wjr.v2.i4.122] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 03/29/2010] [Accepted: 04/12/2010] [Indexed: 02/06/2023] Open
Abstract
Pancreatic tumors are highly diverse, as they can be solid or cystic, and benign or malignant. Since their imaging features overlap considerably, it is often difficult to characterize these tumors. In addition, small pancreatic tumors, especially those less than 2 cm in diameter, are difficult to detect and diagnose. For characterizing pancreatic tumors and detecting small pancreatic tumors, endoscopic ultrasonography (EUS) is the most sensitive of the imaging procedures currently available. This technique also provides good results in terms of the preoperative staging of pancreatic tumors. EUS-guided fine needle aspiration (EUS-FNA) has also proved to be a safe and useful method for tissue sampling of pancreatic tumors. Despite these advantages, however, it is still difficult to differentiate between benign and malignant, solid or cystic pancreatic tumors, malignant neoplasms, and chronic pancreatitis using EUS, even when EUS-FNA is performed. Recently, contrast-enhanced EUS with Doppler mode (CE-EUS) employing ultrasound contrast agents, which indicate vascularization in pancreatic lesions, has been found to be useful in the differential diagnosis of pancreatic tumors, especially small pancreatic tumors. However, Doppler ultrasonography with contrast-enhancement has several limitations, including blooming artifacts, poor spatial resolution, and low sensitivity to slow flow. Consequently, an echoendoscope was developed recently that has a broad-band transducer and an imaging mode that was designed specifically for contrast-enhanced harmonic EUS (CEH-EUS) with a second-generation ultrasound contrast agent. The CEH-EUS technique is expected to improve the differential diagnosis of pancreatic disease in the future. This review describes the EUS appearances of common solid and cystic pancreatic masses, the diagnostic accuracy of EUS-FNA, and the relative efficacies and advantages of CE-EUS and CEH-EUS along with their relative advantages and their complementary roles in clinical practice.
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22
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[Diagnosis of ileal carcinoid with contrast enhanced ultrasonic diagnosis]. ACTA ACUST UNITED AC 2009; 104:564-6. [PMID: 19618143 DOI: 10.1007/s00063-009-1117-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ripollés T, Puig J. Actualización del uso de contrastes en ecografía. Revisión de las guías clínicas de la Federación Europea de Ecografía (EFSUMB). RADIOLOGIA 2009; 51:362-75. [DOI: 10.1016/j.rx.2009.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 04/20/2009] [Accepted: 05/05/2009] [Indexed: 12/27/2022]
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Abstract
Imaging plays a crucial role in the diagnosis of acute and chronic pancreatitis in children. Ultrasound (US) is the primary imaging modality. The US study can be improved by incorporating high resolution imaging, color Doppler, harmonic imaging and panorama view. Computer tomography (CT) is widely used for further evaluation. MR imaging in combination with MR cholangiopancreaticography (MRCP) is emerging as the modality of choice. It is non-invasive and radiation-free. It has high potential to replace endoscopic retrograde cholangiopancreaticography (ERCP), too. The latter is becoming more of an interventional tool. This review discusses the current status and comparative diagnostic potential of US, MRCP and ERCP.
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Affiliation(s)
- Kassa Darge
- Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
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Affiliation(s)
- Timothy P Kinney
- University of Minnesota, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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26
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Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF. Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR 2009; 29:322-40. [PMID: 18853839 DOI: 10.1053/j.sult.2008.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.
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Affiliation(s)
- Mariano Scaglione
- Department of Diagnostic Imaging, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
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27
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Rademacher N, Ohlerth S, Scharf G, Laluhova D, Sieber-Ruckstuhl N, Alt M, Roos M, Grest P, Kaser-Hotz B. Contrast-Enhanced Power and Color Doppler Ultrasonography of the Pancreas in Healthy and Diseased Cats. J Vet Intern Med 2008; 22:1310-6. [DOI: 10.1111/j.1939-1676.2008.0187.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Preliminary study of contrast-enhanced harmonic endosonography with second-generation contrast agents. J Med Ultrason (2001) 2008; 35:11-8. [DOI: 10.1007/s10396-007-0167-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 09/04/2007] [Indexed: 01/09/2023]
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Topal NB, Kaya E, Ercan I, Pourbagher MA, Topal U. The role of Doppler sonography in predicting severity of acute pancreatitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:141-147. [PMID: 18088057 DOI: 10.1002/jcu.20447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE To investigate the role of Doppler sonography (DUS) examination of major abdominal arteries in predicting severity of acute pancreatitis (AP). METHODS Twenty-nine patients diagnosed with AP and 14 controls were blindly and prospectively evaluated with Doppler sonography. Disease severity was defined clinically according to acute physiology and chronic health evaluation (APACHE II) score and was classified as severe for APACHE II score > or =8. DUS examination included the measurement of peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) of the celiac artery (CA) and superior mesenteric artery (SMA). Statistical analysis included Mann-Whitney U test, Student t test, and receiver operating characteristic curve analysis. RESULTS Twelve patients had severe AP and 17 had mild AP. PSV, EDV, and PI of the CA and RI of the SMA were higher in the severe AP group than in the mild AP and control groups (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity were 100% and 94%, respectively, for a 87 cm/second CA PSV cutoff value, 75% and 100%, respectively, for a 22 cm/second CA EDV cutoff value, 92% and 82%, respectively, for a 1.29 CA PI cutoff value, and 100% and 100%, respectively, for a 0.86 SMA RI cutoff value. CONCLUSION DUS can be useful in predicting the severity of AP in the early period of admission phase of the disease.
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Affiliation(s)
- Naile Bolca Topal
- Department of Radiology, Uludag University School of Medicine, 16059 Gorukle, Bursa, Turkey
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Schütte K, Malfertheiner P. Markers for predicting severity and progression of acute pancreatitis. Best Pract Res Clin Gastroenterol 2008; 22:75-90. [PMID: 18206814 DOI: 10.1016/j.bpg.2007.10.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several tools have been developed for severity stratification in acute pancreatitis. They include single biochemical markers, imaging methods, and complex scoring systems, all of which aim at an early detection of severe acute pancreatitis to optimise monitoring and treatment of patients as early as possible. Among single biochemical markers, C-reactive protein (CRP) remains the most useful. Despite its delayed increase, peaking not earlier than 72 h after the onset of symptoms, it is accurate and widely available. Many other markers have been evaluated for their usefulness, and for some of them very promising data could be shown. Among them interleukin 6 seems to be the most promising parameter for use in clinical routine. For the detection of pancreatic infection, procalcitonin is the most sensitive, and can be used as an indicator for the need for fine-needle aspiration of pancreatic necrosis. Regarding imaging, contrast-enhanced computed tomography is still the reference method for the detection of necrotising acute pancreatitis. Pancreatitis-specific scoring systems have been shown to be of value for the prediction of severity and progression of acute pancreatitis, but cannot be applied any earlier than 48 h after admission to hospital. The APACHE-II score has not been developed specifically for acute pancreatitis and is rather complex to assess, but has been proven to be an early and reliable tool. Indication, timing and consequences of the methods applied need to be carefully considered and incorporated into clinical assessments to avoid costs and harm to the patient.
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Affiliation(s)
- Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
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31
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Bollen TL, van Santvoort HC, Besselink MGH, van Es WH, Gooszen HG, van Leeuwen MS. Update on acute pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 2008; 28:371-83. [PMID: 17970553 DOI: 10.1053/j.sult.2007.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Imaging of patients with acute pancreatitis requires an understanding of the subtypes and complications that were defined at the Atlanta symposium in 1992. In the last decade, several new entities have been recognized with important clinical implications. In this article, the radiological aspects of the terminology and classification of acute pancreatitis are reviewed and new entities are clarified. The roles of ultrasound, computed tomography, and magnetic resonance imaging in the diagnosis and evaluation of acute pancreatitis and its complications are discussed and the limitations of each imaging technique, when interpreting pancreatic and peripancreatic inflammatory disease, are addressed.
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Affiliation(s)
- Thomas L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Kitano M, Sakamoto H, Matsui U, Ito Y, Maekawa K, von Schrenck T, Kudo M. A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008; 67:141-50. [PMID: 18155437 DOI: 10.1016/j.gie.2007.07.045] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 07/30/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Contrast-enhanced harmonic-imaging techniques have been unavailable for EUS because of the limited frequency bandwidth and acoustic power output of current echoendoscopes. OBJECTIVE To investigate the contrast harmonic imaging technique by using a prototype echoendoscope equipped with an adequate broad-band transducer that can detect harmonic signals from the US contrast agents. DESIGN Identification of optimal settings (study I) and preliminary clinical investigations (study II). SETTING Bethesda General Hospital Bergedorf. PATIENTS A total of 104 patients undergoing standard EUS examinations. INTERVENTIONS Contrast-enhanced harmonic EUS (CEH-EUS) was performed by using a prototype echoendoscope and extended pure harmonic detection mode, a specific mode for contrast harmonic imaging. MAIN OUTCOME MEASUREMENTS In study I, time-intensity curves for peak signal intensity were calculated after infusion of a contrast agent, SonoVue, and the changes in echo intensity were compared for different mechanical indices and interval times. In study II, intermittent and real-time continuous images of pancreatobiliary and gastroduodenal diseases obtained by CEH-EUS were evaluated in comparison with contrast-enhanced power-Doppler EUS (CED-EUS). RESULTS In study I, with the optimal mechanical index (0.4), homogeneous parenchymal perfusion images of the pancreas were obtained by intermittent imaging, and finely branching vessels of the pancreas were obtained with real-time continuous imaging. In study II, apparent perfusion and vessel images were observed in pancreatobiliary carcinomas, GI stromal tumors, and lymph-node metastases. CED-EUS failed to depict images of the fine vessels and parenchymal perfusion. LIMITATIONS The subjective nature of the findings, with a limited number of patients. CONCLUSIONS CEH-EUS successfully visualized parenchymal perfusion and microvasculature in the pancreas and may play an important role in the differential diagnosis of digestive diseases.
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Rickes S, Mönkemüller K, Malfertheiner P. Acute severe pancreatitis: contrast-enhanced sonography. ACTA ACUST UNITED AC 2007; 32:362-4. [PMID: 17514345 DOI: 10.1007/s00261-007-9250-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Early assessment and differentiation of oedematous acute pancreatitis and necrotizing or severe acute pancreatitis allow distinct therapeutic algorithms. Spiral computed tomography is currently considered the gold standard for staging of acute severe pancreatitis. Conventional transabdominal ultrasound plays only a limited role in the staging of acute pancreatitis. The problem is that with this procedure a detection of pancreatic necrosis is difficult because it cannot assess organ perfusion. Through the use of contrast-enhancers, however, even ultrasound can nowadays examine the vascularization behaviour of the pancreas and liver parenchyma in sufficient detail. The aim of the present update article is to explain the usefulness of contrast-enhanced ultrasound in the detection of parenchymal necrosis in patients with acute severe pancreatitis.
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Affiliation(s)
- Steffen Rickes
- Department of Gastroenterology, Hepatology and Infectious Diseases Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
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Del Chiaro M, Zerbi A, Falconi M, Bertacca L, Polese M, Sartori N, Boggi U, Casari G, Longoni BM, Salvia R, Caligo MA, Di Carlo V, Pederzoli P, Presciuttini S, Mosca F. Cancer risk among the relatives of patients with pancreatic ductal adenocarcinoma. Pancreatology 2007; 7:459-69. [PMID: 17912010 DOI: 10.1159/000108963] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 03/23/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Pancreatic cancer is a leading cause of cancer-related death; the most consistently identified risk factors are smoking and family history. Our aims were to examine familial aggregations of pancreas and other cancers, and to determine the relative risk of the family members. METHODS We prospectively collected data on the families of patients presenting with pancreatic ductal adenocarcinoma. Smoking habits and alcohol consumption of the probands were compared with the available statistics on the Italian population. Mortality from cancer was investigated in first-degree relatives, and age-dependent risks of dying from pancreatic cancer and other tumors were compared with background population levels. RESULTS Data for 570 families were collected, including 9,204 relatives. Probands were 3- to 5-fold more often heavy smokers than the general population, and 9.3% of them reported a positive family history of pancreatic cancer. In first-degree relatives, only mortality from pancreatic cancer was significantly increased (relative risk at age 85 years = 2.7). Lifetime risk of dying of pancreas cancer was 4.1% for the relatives of all probands, and was 7.2% for the relatives of probands who developed disease before 60 years of age. CONCLUSIONS The data suggest that genetic susceptibility to pancreatic cancer may be attributable, in addition to BRCA2, to moderate- to low-penetrance gene(s).
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Affiliation(s)
- Marco Del Chiaro
- Regional Referral Center for Pancreatic Diseases Treatment, University of Pisa, Pisa, Italy.
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Rickes S, Rauh P, Uhle C, Ensberg D, Mönkemüller K, Malfertheiner P. Contrast-enhanced sonography in pancreatic diseases. Eur J Radiol 2007; 64:183-8. [PMID: 17869470 DOI: 10.1016/j.ejrad.2007.06.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 05/26/2007] [Accepted: 06/06/2007] [Indexed: 12/18/2022]
Abstract
Contrast-enhanced sonography is a widely available imaging modality for the diagnosis of pancreatic diseases. With this procedure, pancreatic tumours can be differentiated better. Furthermore, contrast-enhanced sonography produces good results in the staging of acute pancreatitis severity, especially in the detection of pancreatic necrosis. In this review article the value of contrast-enhanced sonography in the diagnosis of pancreatic diseases will be described and discussed.
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Affiliation(s)
- Steffen Rickes
- Department of Internal Medicine, AMEOS Hospital GmbH, Halberstadt, Germany.
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Kirby JM, Vora P, Midia M, Rawlinson J. Vascular complications of pancreatitis: imaging and intervention. Cardiovasc Intervent Radiol 2007; 31:957-70. [PMID: 17680304 DOI: 10.1007/s00270-007-9138-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 06/05/2007] [Accepted: 06/23/2007] [Indexed: 02/07/2023]
Abstract
The objective of this study was to highlight technical challenges and potential pitfalls of diagnostic imaging, intervention, and postintervention follow-up of vascular complications of pancreatitis. Diagnostic and interventional radiology imaging from patients with pancreatitis from 2002 to 2006 was reviewed. We conclude that biphasic CT is the diagnostic modality of choice. Catheter angiography may (still) be required to diagnose small pseudoaneurysms. Endovascular coiling is the treatment of choice for pseudoaneurysms. Close clinical follow-up is required, as patients may rebleed/develop aneurysms elsewhere.
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Affiliation(s)
- John M Kirby
- McMaster University Medical Center, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
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Besselink MGH, van Santvoort HC, Witteman BJ, Gooszen HG. Management of severe acute pancreatitis: it's all about timing. Curr Opin Crit Care 2007; 13:200-6. [PMID: 17327743 DOI: 10.1097/mcc.0b013e328015b8af] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This study provides an update on the treatment of severe acute pancreatitis (SAP) with emphasis on nutrition, infection-prophylaxis, biliary pancreatitis, surgical intervention and new randomized controlled trials. RECENT FINDINGS The most relevant new insights are: (i) early enteral nutrition in SAP is not only capable of reducing infectious complications but may also reduce mortality; (ii) there is increasing evidence that antibiotic-prophylaxis is not capable of preventing infectious complications in SAP; (iii) probiotic-prophylaxis is being considered as an alternative with promising experimental results; (iv) in biliary pancreatitis, early endoscopic retrograde cholangiography with sphincterotomy (within 48 h) is beneficial in case of ampullary obstruction, although it may be withheld in the event of negative endoscopic ultrasound; (v) surgical intervention for infected (peri-)pancreatic necrosis is increasingly being postponed; (vi) minimally invasive strategies are being considered as a full alternative for necrosectomy by laparotomy in infected (peri-)pancreatic necrosis; (vii) the Atlanta classification should no longer be used to describe computed tomography findings in acute pancreatitis; and (viii) only five randomized controlled trials of patients with acute pancreatitis are currently registered in the international trial registries. SUMMARY Timing of intervention is becoming increasingly important in SAP management.
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Affiliation(s)
- Marc G H Besselink
- Department of Surgery, University Medical Center Utrecht, The Netherlands.
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Gethins S, Robinson R, de Caestecker J, Stewart J. Impact of a nurse−led telephone clinic on quality of IBD care. ACTA ACUST UNITED AC 2007. [DOI: 10.12968/gasn.2007.5.1.29429] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sharon Gethins
- University Hospitals of Leicester NHS Trust Digestive Diseases Centre, Glenfield Hospital, Leicester
| | - Richard Robinson
- University Hospitals of Leicester NHS Trust Digestive Diseases Centre, Glenfield Hospital, Leicester
| | - John de Caestecker
- University Hospitals of Leicester NHS Trust Digestive Diseases Centre, Glenfield Hospital, Leicester
| | - James Stewart
- University Hospitals of Leicester NHS Trust Digestive Diseases Centre, Glenfield Hospital, Leicester
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Abstract
Gallstones are the most common cause of acute pancreatitis in the western world. Most patients with ABP suffer a mild attack and are expected to make a full recovery. They can be managed supportively and undergo laparoscopic cholecystectomy with IOC during their initial hospitalization to prevent recurrence. If necessary, laparoscopic common bile duct exploration can be performed. Otherwise, postoperative ERCP can be performed to remove common bile duct stones. Patients with severe ABP require ICU admission, close clinical monitoring, and aggressive fluid resuscitation. There is a bimodal mortality in severe ABP with most late deaths caused by septic complications. Antibiotics should be used judiciously and are usually warranted only in the presence of infection or sepsis. ERCP, +/- ES, should be performed when signs of cholangitis are present. Early ERCP should be considered in patients with severe ABP who do not improve clinically. CT scanning should be performed to assess for necrosis or peripancreatic fluid collections. Patients with no fluid collections can undergo cholecystectomy once their clinical condition improves. Patients with peripancreatic fluid collections should be followed with serial CT scans. Laparoscopic cholecystectomy should be performed once resolution of the fluid collection is documented. If fluid collections do not resolve after 6 weeks, patients should undergo concurrent cholecystectomy and fluid drainage procedures. Sterile necrosis can be closely monitored and does not require necrosectomy unless the patient's clinical status deteriorates. Patients with infected necrosis should undergo necrosectomy when they are clinically stable. After recovery from an attack of severe ABP, patients require close follow-up because late complications are common. Currently, no single test can establish the diagnosis or predict the severity of ABP. A prompt diagnosis requires a high degree of suspicion and clinical acumen. Recognizing patients with severe pancreatitis is an important priority because it affects the type and timing of intervention. The management of these patients requires close clinical observation and a multidisciplinary approach between the surgeon, radiologist, gastroenterologist, and intensivist.
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Affiliation(s)
- Shawn D Larson
- Department of Surgery, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0536, USA
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ISHIHARA T, YAMAGUCHI T, YOKOSUKA O, MATSUTANI S, SAITO H. Imaging of acute pancreatitis and chronic pancreatitis: the role of transabdominal ultrasound. CHOONPA IGAKU 2007; 34:283-292. [DOI: 10.3179/jjmu.34.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Abstract
This review discusses the current imaging modalities for the diagnosis and staging of solid and cystic pancreatic lesions and for the assessment of acute and chronic pancreatitis, and the future role of emerging technologies in the management of pancreatic diseases. Multidetector row spiral computed tomography is superior to conventional single-detector row spiral computed tomography in the detection and staging of pancreatic adenocarcinoma. Positron emission tomography is a sensitive but relatively nonspecific diagnostic modality. Positron emission tomography-computed tomography fusion may improve the staging accuracy for pancreatic cancer. Echo-enhanced ultrasound may have an emerging role in evaluating pancreatic masses. Endoscopic ultrasound with fine needle aspiration for cytology is the single best method for diagnosis and staging of nonmetastatic pancreatic cancer with a high accuracy for determining tumor resectability. In acute pancreatitis, a modification of the standard computed tomography severity index, which places greater emphasis on extrapancreatic complications, has shown superior correlation with various patient outcome measures. Endoscopic retrograde cholangiopancreatography is still the test of choice for morphological evaluation of chronic pancreatitis, whereas magnetic resonance cholangiopancreatography offers a noninvasive alternative in selected patients. Endoscopic ultrasound can be useful for detecting early chronic pancreatitis. Secretin-stimulated imaging techniques may eventually provide a noninvasive method of reliably assessing pancreatic exocrine function.
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Affiliation(s)
- Matthew T Nichols
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045, USA
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Abstract
PURPOSE OF REVIEW This review serves to highlight new technology and novel applications of existing techniques and their role in the management of pancreatic diseases, including acute and chronic pancreatitis, pancreatic cancer, and pancreatic cystic neoplasms. RECENT FINDINGS Contrast-enhanced ultrasound has shown promise in evaluating the severity of acute pancreatitis, staging pancreatic cancer, and predicting malignancy in cystic neoplasms. Optical coherence tomography within the pancreatic duct appears to be able to differentiate malignant and normal pancreatic ducts. Spectroscopy may prove useful in differentiating focal chronic pancreatitis from malignancy. Multidetector-row computed tomography may provide more accurate information regarding cancer respectability and differentiation between ductal type of intraductal papillary mucinous tumors. SUMMARY These new developments will help with the diagnosis and staging of pancreatic diseases.
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Affiliation(s)
- Richard S Kwon
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Rickes S, Mönkemüller K, Peitz U, Schinkel S, Kolfenbach S, Malfertheiner P, Ebert MPA. Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst. Scand J Gastroenterol 2006; 41:989-92. [PMID: 16803699 DOI: 10.1080/00365520600581553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This is the first report of a case of biliopancreatic fistula complicating a pancreatic pseudocyst diagnosed correctly by transabdominal ultrasound. The diagnosis was confirmed by magnetic resonance and endoscopic retrograde cholangiopancreatography. The fistula was treated successfully with biliary stenting. The clinical and imaging features of this exceptional complication are presented along with a brief review of the topic.
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Affiliation(s)
- Steffen Rickes
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University, Magdeburg, Germany.
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