Advertisement

Utility of the portal venous phase for diagnosing pancreatic necrosis in acute pancreatitis using the CT severity index

  • Yoshifumi Noda
  • Satoshi Goshima
  • Keita Fujimoto
  • Hiroshi Kawada
  • Nobuyuki Kawai
  • Yukichi Tanahashi
  • Masayuki Matsuo
Article

Abstract

Purpose

The purpose of the study was to evaluate the value of portal venous phase (PVP) images in the diagnosis of pancreatic necrosis in patients with acute pancreatitis using computed tomography severity index (CTSI).

Methods

This retrospective study was approved by our Institutional Review Board, and written informed consent was waived. Dynamic contrast-enhanced CT images, with the pancreatic parenchymal phase (PPP) and the PVP, were obtained from 56 consecutive patients with acute pancreatitis. Two radiologists reviewed two sets of images, namely PPP images alone (image set A) and combined PPP and PVP images (image set B) to evaluate the CTSI. Cases were categorized as necrotizing pancreatitis if ensuing walled-off necrosis formation was identified 4 weeks after onset of symptoms. The relationship between pancreatic necrosis and CTSI was compared between image sets A and B. Logistic regression analysis was performed to evaluate the significance of clinical and radiological factors associated with the diagnosis of pancreatic necrosis.

Results

Pancreatic necrosis was confirmed in 14 out of 56 (25%) patients. The area under the receiver-operating-characteristic curve (AUC) for the diagnosis of pancreatic necrosis was 0.70 and 0.78 for image sets A and B, respectively. The AUC for image set B was significantly greater than that for image set A (P = 0.0002). Logistic regression analysis demonstrated that among clinical and radiological factors tested, CTSI for image set B was independently correlated with pancreatic necrosis (P = 0.025).

Conclusions

Combined PPP and PVP images significantly improved the diagnostic accuracy of pancreatic necrosis following acute pancreatitis.

Keywords

Pancreatitis Multidetector computed tomography Contrast media Acute necrotizing pancreatitis Diagnostic imaging 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare relevant conflicts of interest to disclose.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The requirement for informed consent was waived by our Institutional Review Board.

Informed consent

The requirement for informed consent was waived by our Institutional Review Board.

References

  1. 1.
    Fagenholz PJ, Fernandez-del Castillo C, Harris NS, Pelletier AJ, Camargo CA Jr (2007) Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas 35(4):302–307.  https://doi.org/10.1097/mpa.0b013e3180cac24b CrossRefPubMedGoogle Scholar
  2. 2.
    Lankisch PG, Apte M, Banks PA (2015) Acute pancreatitis. Lancet 386(9988):85–96.  https://doi.org/10.1016/s0140-6736(14)60649-8 CrossRefPubMedGoogle Scholar
  3. 3.
    Banks PA, Bollen TL, Dervenis C, et al. (2013) Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 62(1):102–111.  https://doi.org/10.1136/gutjnl-2012-302779 CrossRefPubMedGoogle Scholar
  4. 4.
    Blum T, Maisonneuve P, Lowenfels AB, Lankisch PG (2001) Fatal outcome in acute pancreatitis: its occurrence and early prediction. Pancreatology 1(3):237–241.  https://doi.org/10.1159/000055817 CrossRefPubMedGoogle Scholar
  5. 5.
    Gloor B, Muller CA, Worni M, et al. (2001) Late mortality in patients with severe acute pancreatitis. Br J Surg 88(7):975–979.  https://doi.org/10.1046/j.0007-1323.2001.01813.x CrossRefPubMedGoogle Scholar
  6. 6.
    Guo Q, Li A, Xia Q, et al. (2014) The role of organ failure and infection in necrotizing pancreatitis: a prospective study. Ann Surg 259(6):1201–1207.  https://doi.org/10.1097/sla.0000000000000264 CrossRefPubMedGoogle Scholar
  7. 7.
    Hartwig W, Werner J, Muller CA, Uhl W, Buchler MW (2002) Surgical management of severe pancreatitis including sterile necrosis. J Hepato-biliary-pancreat Surg 9(4):429–435.  https://doi.org/10.1007/s005340200053 CrossRefGoogle Scholar
  8. 8.
    Hughes SJ, Papachristou GI, Federle MP, Lee KK (2007) Necrotizing pancreatitis. Gastroenterol Clin N Am 36(2):313–323, viii.  https://doi.org/10.1016/j.gtc.2007.03.012
  9. 9.
    Balthazar EJ (2002) Staging of acute pancreatitis. Radiol Clin N Am 40(6):1199–1209CrossRefPubMedGoogle Scholar
  10. 10.
    Mortele KJ, Ip IK, Wu BU, et al. (2011) Acute pancreatitis: imaging utilization practices in an urban teaching hospital—analysis of trends with assessment of independent predictors in correlation with patient outcomes. Radiology 258(1):174–181.  https://doi.org/10.1148/radiol.10100320 CrossRefPubMedGoogle Scholar
  11. 11.
    Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 174(2):331–336.  https://doi.org/10.1148/radiology.174.2.2296641 CrossRefPubMedGoogle Scholar
  12. 12.
    Taydas O, Unal E, Karaosmanoglu AD, Onur MR, Akpinar E (2018) Accuracy of early CT findings for predicting disease course in patients with acute pancreatitis. Jpn J Radiol 36(2):151–158.  https://doi.org/10.1007/s11604-017-0709-9 CrossRefPubMedGoogle Scholar
  13. 13.
    Thoeni RF (2012) The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology 262(3):751–764.  https://doi.org/10.1148/radiol.11110947 CrossRefPubMedGoogle Scholar
  14. 14.
    Working Group IAPAPAAPG (2013) IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4 Suppl 2):e1–e15.  https://doi.org/10.1016/j.pan.2013.07.063 Google Scholar
  15. 15.
    Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223(3):603–613.  https://doi.org/10.1148/radiol.2233010680 CrossRefPubMedGoogle Scholar
  16. 16.
    Kalra MK, Maher MM, Toth TL, et al. (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233(3):649–657.  https://doi.org/10.1148/radiol.2333031150 CrossRefPubMedGoogle Scholar
  17. 17.
    Goshima S, Kanematsu M, Kondo H, et al. (2006) Pancreas: optimal scan delay for contrast-enhanced multi-detector row CT. Radiology 241(1):167–174.  https://doi.org/10.1148/radiol.2411051338 CrossRefPubMedGoogle Scholar
  18. 18.
    Kondo H, Kanematsu M, Goshima S, et al. (2007) MDCT of the pancreas: optimizing scanning delay with a bolus-tracking technique for pancreatic, peripancreatic vascular, and hepatic contrast enhancement. Am J Roentgenol 188(3):751–756.  https://doi.org/10.2214/ajr.06.0372 CrossRefGoogle Scholar
  19. 19.
    Takahashi N, Papachristou GI, Schmit GD, et al. (2008) CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol 18(11):2522–2529.  https://doi.org/10.1007/s00330-008-1039-1 CrossRefPubMedGoogle Scholar
  20. 20.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148(3):839–843.  https://doi.org/10.1148/radiology.148.3.6878708 CrossRefPubMedGoogle Scholar
  21. 21.
    McNulty NJ, Francis IR, Platt JF, et al. (2001) Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220(1):97–102.  https://doi.org/10.1148/radiology.220.1.r01jl1897 CrossRefPubMedGoogle Scholar
  22. 22.
    Balthazar EJ, Freeny PC, vanSonnenberg E (1994) Imaging and intervention in acute pancreatitis. Radiology 193(2):297–306.  https://doi.org/10.1148/radiology.193.2.7972730 CrossRefPubMedGoogle Scholar
  23. 23.
    Funnell IC, Bornman PC, Weakley SP, Terblanche J, Marks IN (1993) Obesity: an important prognostic factor in acute pancreatitis. Br J Surg 80(4):484–486CrossRefPubMedGoogle Scholar
  24. 24.
    Mofidi R, Duff MD, Wigmore SJ, et al. (2006) Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 93(6):738–744.  https://doi.org/10.1002/bjs.5290 CrossRefPubMedGoogle Scholar
  25. 25.
    Brown A, Orav J, Banks PA (2000) Hemoconcentration is an early marker for organ failure and necrotizing pancreatitis. Pancreas 20(4):367–372CrossRefPubMedGoogle Scholar
  26. 26.
    Mounzer R, Langmead CJ, Wu BU, et al. (2012) Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 142(7):1476–1482; quiz e1415–1476.  https://doi.org/10.1053/j.gastro.2012.03.005
  27. 27.
    Bollen TL, Singh VK, Maurer R, et al. (2012) A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol 107(4):612–619.  https://doi.org/10.1038/ajg.2011.438 CrossRefPubMedGoogle Scholar
  28. 28.
    Khanna AK, Meher S, Prakash S, et al. (2013) Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg 2013:367581.  https://doi.org/10.1155/2013/367581 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Bollen TL, Singh VK, Maurer R, et al. (2011) Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. Am J Roentgenol 197(2):386–392.  https://doi.org/10.2214/ajr.09.4025 CrossRefGoogle Scholar
  30. 30.
    Zaheer A, Singh VK, Qureshi RO, Fishman EK (2013) The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines. Abdom Imaging 38(1):125–136.  https://doi.org/10.1007/s00261-012-9908-0 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yoshifumi Noda
    • 1
  • Satoshi Goshima
    • 1
  • Keita Fujimoto
    • 1
  • Hiroshi Kawada
    • 1
  • Nobuyuki Kawai
    • 1
  • Yukichi Tanahashi
    • 1
  • Masayuki Matsuo
    • 1
  1. 1.Department of RadiologyGifu UniversityGifuJapan

Personalised recommendations