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Juhász MF, Sipos Z, Ocskay K, Hegyi P, Nagy A, Párniczky A. Admission risk factors and predictors of moderate or severe pediatric acute pancreatitis: A systematic review and meta-analysis. Front Pediatr 2022; 10:947545. [PMID: 36245710 PMCID: PMC9561825 DOI: 10.3389/fped.2022.947545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Pediatric acute pancreatitis (PAP) has an increasing incidence and is now estimated to be almost as common as in adults. Up to 30% of patients with PAP will develop moderate or severe disease course (M/SPAP), characterized by organ failure, local or systemic complications. There is still no consensus regarding on-admission severity prediction in these patients. Our aim was to conduct a systematic review and meta-analysis of available predictive score systems and parameters, and differences between on-admission parameters in mild and M/SPAP. Methods We conducted a systematic search on the 14th February, 2022 in MEDLINE, Embase and CENTRAL. We performed random-effects meta-analysis of on-admission differences between mild and M/SPAP in laboratory parameters, etiology, demographic factors, etc. calculating risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) and created forest plots. For the meta-analysis of predictive score systems, we generated hierarchical summary receiver operating characteristic curves using a bivariate model. Chi-squared tests were performed and I2 values calculated to assess statistical heterogeneity. Results We included 44 studies - mostly retrospective cohorts - in our review. Among predictive score systems examined by at least 5 studies, the modified Glasgow scale had the highest specificity (91.5% for values ≥3), and the Pediatric Acute Pancreatitis Severity score the highest sensitivity (63.1% for values ≥3). The performance of other proposed score systems and values were summarized. Traumatic (RR: 1.70 95% CI: 1.09-2.67) and drug-induced (RR: 1.33 95% CI: 0.98-1.87) etiologies were associated with a higher rate of M/SPAP, while anatomical (RR: 0.6195% CI: 0.38-0.96) and biliary (RR: 0.72 95% CI: 0.53-0.99) PAP tended to be less severe. Discussion Many predictive score systems were proposed to assess the possibility of M/SPAP course. The most commonly used ones exhibit good specificity, but subpar sensitivity. Our systematic review provides a rigorous overview of predictive options assessed thus far, that can serve as a basis for future improvement of scores via the addition of parameters with a better observed sensitivity: e.g., lipase exceeding 7-times the upper threshold, hemoglobin, etc. The addition of etiological factors is another possibility, as they can herald a more severe disease course. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=307271, PROSPERO, identifier: CRD42022307271.
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Affiliation(s)
- Márk Félix Juhász
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Zoltán Sipos
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Klementina Ocskay
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anikó Nagy
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Andrea Párniczky
- Heim Pál National Pediatric Institute, Budapest, Hungary
- Medical School, Institute for Translational Medicine, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Froes CD, Gosal K, Singh P, Collier V. The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis. Cureus 2022; 14:e27752. [PMID: 36106274 PMCID: PMC9445414 DOI: 10.7759/cureus.27752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/21/2022] Open
Abstract
Aim Acute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features. Methods A retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs). Results Patients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females. Conclusion Performing AUS within 48 hours following negative CTAP in this cohort of patients admitted for acute pancreatitis was associated with a decreased LOS. Furthermore, patients who underwent AUS were more likely to undergo ERCP and even more likely to undergo cholecystectomy. The likelihood of ERCP and cholecystectomy increased proportionally to both age and BMI. Females were more likely than males to undergo subsequent ERCP or cholecystectomy.
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Beyer G, Hoffmeister A, Michl P, Gress TM, Huber W, Algül H, Neesse A, Meining A, Seufferlein TW, Rosendahl J, Kahl S, Keller J, Werner J, Friess H, Bufler P, Löhr MJ, Schneider A, Lynen Jansen P, Esposito I, Grenacher L, Mössner J, Lerch MM, Mayerle J. S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:419-521. [PMID: 35263785 DOI: 10.1055/a-1735-3864] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Patrick Michl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Deutschland
| | - Wolfgang Huber
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Hana Algül
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Deutschland
| | - Alexander Meining
- Medizinische Klinik und Poliklinik II Gastroenterologie und Hepatologie, Universitätsklinikum Würzburg, Deutschland
| | | | - Jonas Rosendahl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Stefan Kahl
- Klinik für Innere Medizin m. Schwerpkt. Gastro./Hämat./Onko./Nephro., DRK Kliniken Berlin Köpenick, Deutschland
| | - Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Jens Werner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - Philip Bufler
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Deutschland
| | - Matthias J Löhr
- Department of Gastroenterology, Karolinska, Universitetssjukhuset, Stockholm, Schweden
| | - Alexander Schneider
- Klinik für Gastroenterologie und Hepatologie, Klinikum Bad Hersfeld, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Irene Esposito
- Pathologisches Institut, Heinrich-Heine-Universität und Universitätsklinikum Duesseldorf, Duesseldorf, Deutschland
| | - Lars Grenacher
- Conradia Radiologie München Schwabing, München, Deutschland
| | - Joachim Mössner
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
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[Imaging diagnostics in acute pancreatitis]. Internist (Berl) 2021; 62:1044-1054. [PMID: 34524469 DOI: 10.1007/s00108-021-01153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
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.
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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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Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepatogastroenterol 2017; 7:1-5. [PMID: 29201763 PMCID: PMC5663765 DOI: 10.5005/jp-journals-10018-1202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/25/2016] [Indexed: 12/30/2022] Open
Abstract
AIM The assessment of the severity of acute pancreatitis (AP) is important for proper management of the disease and for its prognosis. The aim was to correlate clinical, biochemical, and imaging diagnostic parameters and evaluate their prognostic values in the early assessment of severity of AP. MATERIALS AND METHODS We prospectively studied 128 consecutive patients with AP. The predictors were clinical, biochemical, and imaging diagnostic parameters. The outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced computer tomography, and pancreatitis-specific clinical and laboratory findings were done. RESULTS According to the Atlanta classification, 84 patients (65.6%) had mild and 44 (34.4%) had severe AP. The severity markers were significantly different between the mild and the severe groups (p < 0.001). Leukocyte count, serum albumin level, C-reactive protein (CRP), Ranson, acute physiology and chronic health evaluation II (APACHE II), and Glasgow score were the factors associated with radiological severity grade. Leukocyte count, CRP, Ranson score, APACHE II, and Glasgow score were the factors associated with the number and appearance of acute fluid collections (AFCs). A significant association was found between the number of AFCs and the occurrence of complications [odds ratio 4.4; 95% confidence interval 2.5-7.6]. Hospital stay was significantly longer in the group with severe disease as compared with the group with mild disease (p < 0.001). CONCLUSION Clinical, biochemical, and imaging diagnostic parameters are related to the clinical course of AP and they can predict its severity. This allows us to determine the severity of the disease and to target the patients with high scores for close monitoring and more aggressive intervention.How to cite this article: Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepato-Gastroenterol 2017;7(1):1-5.
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Affiliation(s)
- Dina Zerem
- Medical Faculty, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Omar Zerem
- Medical Faculty, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Enver Zerem
- Department of Medical Sciences, The Academy of Sciences and Arts of Bosnia and Herzegovina, 71000 Sarajevo, Bosnia and Herzegovina
- Department of Gastroenterology, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina
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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: 7] [Impact Index Per Article: 0.8] [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
- Correspondence to: Dr Yan Luo, Department of Ultrasound, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan 610041, P.R. China, E-mail:
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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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Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yener Ö. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis. Diagn Interv Imaging 2014; 96:151-60. [PMID: 24512896 DOI: 10.1016/j.diii.2013.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.
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Affiliation(s)
- A Türkvatan
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey.
| | - A Erden
- Department of Radiology, Ankara University School of Medicine, Talatpaşa Street, 06100 Sıhhiye, Ankara, Turkey
| | - M A Türkoğlu
- Department of General Surgery, Akdeniz University School of Medicine, Dumlupınar street, Antalya, Turkey
| | - M Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Cumhuriyet street, İzmir, Turkey
| | - Ö Yener
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey
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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: 11/13/2013] [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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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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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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