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Acute severe pancreatitis: contrast-enhanced sonography

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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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References

  1. Sarner M, Cotton PB (1984) Classification of pancreatitis. Gut 25:756–759

    PubMed  CAS  Google Scholar 

  2. Bradley III EL (1994) The necessity for a clinical classification of acute pancreatitis: the Atlanta system. In: Bradley EL III, (ed). Acute pancreatitis, diagnosis and therapy. New York: Raven Press, pp 53–62

    Google Scholar 

  3. Poston GJ, Williamson RCN (1990) Surgical management of acute pancreatitis. Br J Surg 77:5–12

    Article  PubMed  CAS  Google Scholar 

  4. Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–613

    Article  PubMed  Google Scholar 

  5. Banks PA (1997) Practice guidelines in acute pancreatitis. Am J Gastroenterol 92:377–386

    PubMed  CAS  Google Scholar 

  6. Balthazar EJ, Robinson DL, Megibow AJ, et al. (1990) Acute pancreatitis: value of CT in establishing diagnosis. Radiology 174:331–336

    PubMed  CAS  Google Scholar 

  7. Foitzik T, Bassi DG, Schmidt J, et al. (1994) Intravenous contrast medium accentuates the severity of acute necrotizing pancreatitis in the rat. Gastroenterology 106:207–214

    PubMed  CAS  Google Scholar 

  8. Foitzik T, Bassi DG, Fernandez-del Castillo C (1994) Intravenous contrast medium impairs oxygenation of the pancreas in acute necrotizing pancreatitis in the rat. Arch Surg 129:706–711

    PubMed  CAS  Google Scholar 

  9. Schmidt J, Hotz HJ, Foitzik T, et al. (1995) Intravenous contrast medium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat. Ann Surg 221:257–264

    Article  PubMed  CAS  Google Scholar 

  10. Carmona-Sanchez R, Uscanga L, et al. (2000) Potential harmful effect of iodinated intravenous contrast medium on the clinical course of mild acute pancreatitis. Arch Surg 135:1280–1284

    Article  PubMed  CAS  Google Scholar 

  11. Uhl W, Roggo A, Kirschstein T, et al. (2002) Influence of contrast-enhanced computed tomography on course and outcome in patients with acute pancreatitis. Pancreas 24:191–197

    Article  PubMed  Google Scholar 

  12. Rickes S, Unkrodt K, Ocran K, et al. (2003) Differentiation of neuroendocrine tumours from other pancreatic lesions by echo-enhanced power Doppler sonography and somatostatin receptor scintigraphy. Pancreas 26:76–81

    Article  PubMed  CAS  Google Scholar 

  13. Rickes S, Unkrodt K, Neye H, et al. (2002) Differentiation of pancreatic tumours by conventional ultrasound, unenhanced and echo-enhanced power Doppler sonography. Scand J Gastroenterol 37:1313–1320

    Article  PubMed  CAS  Google Scholar 

  14. Rickes S, Wermke W (2004) Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound. J Gastroenterol Hepatol 19:761–766

    Article  PubMed  Google Scholar 

  15. Rickes S, Schulze S, Neye H, et al. (2003) Improved diagnosing of small hepatocellular carcinomas by echo-enhanced power Doppler sonography in patients with cirrhosis. Eur J Gastroenterol Hepatol 15:893–900

    Article  PubMed  Google Scholar 

  16. Schlottmann K, Kratzer W, Schölmerich J (2005) Doppler ultrasound and intravenous contrast agents in gastrointestinal tract disorders: current role and future implications. Eur J Gastroenterol Hepatol 17:263–275

    Article  PubMed  Google Scholar 

  17. Rickes S, Ocran K, Schulze S, et al. (2002) Evaluation of Doppler sonographic criteria for the differentiation of hepatocellular carcinomas and regenerative nodules in patients with liver cirrhosis. Ultraschall Med 23:83–90

    Article  PubMed  CAS  Google Scholar 

  18. Rickes S, Unkrodt K, Ocran K, et al. (2000) Evaluation of doppler ultrasonography criteria for the differential diagnosis of pancreatic tumours. Ultraschall Med 20:253–258

    Article  Google Scholar 

  19. Garg M, Sandhu M, Sood B, et al. (2004) Tissue harmonic imaging in the evaluation of acute pancreatitis. Australas Radiol 48:117–122

    Article  PubMed  Google Scholar 

  20. Rickes S, Uhle C, Kahl S, et al. (2006) Echo-enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis. Gut 55:74–78

    Article  PubMed  CAS  Google Scholar 

  21. Arvanitakis M, Delhaye M, De Maertelaere V, et al. (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 126:715–723

    Article  PubMed  Google Scholar 

  22. Baron TH, Morgan DE (1999) Acute necrotizing pancreatitis. N Engl J Med 340:1412–1417

    Article  PubMed  CAS  Google Scholar 

  23. Vege SS, Baron TH. (2005) Management of pancreatic necrosis in severe acute pancreatitis. Clin Gastroenterol Hepatol 3:192–196

    Article  PubMed  Google Scholar 

  24. Uhl W, Warshaw A, Imrie C, et al. (2002) IAP Guidelines for the surgical management of acute pancreatitis. Pancreatology 2:565–573

    Article  PubMed  Google Scholar 

  25. Raraty MG, Connor S, Criddle DN, et al. (2004) Acute pancreatitis and organ failure: pathophysiology, natural history, and management strategies. Curr Gastroenterol Rep 6:99–103

    Article  PubMed  Google Scholar 

  26. Shankar S, van Sonnenberg E, Silverman SG, et al. (2004) Imaging and percutaneous management of acute complicated pancreatitis. Cardiovasc Intervent Radiol 27:567–580

    Article  PubMed  Google Scholar 

  27. Albrecht T, Blomley M, Bolondi L, et al. (2004) Guidelines for the use of contrast agents in ultrasound. Ultraschall Med 25:249–256

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Steffen Rickes.

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Rickes, S., Mönkemüller, K. & Malfertheiner, P. Acute severe pancreatitis: contrast-enhanced sonography. Abdom Imaging 32, 362–364 (2007). https://doi.org/10.1007/s00261-007-9250-0

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