Echo-enhanced ultrasound – A new valid initial imaging approach for severe acute pancreatitis

Abstract

Aim: This prospective study aimed to compare the accuracy of echo enhanced ultrasound with spiral computed tomography (CT) in assessing acute pancreatitis and to explore the correlation between ultrasound findings and clinical outcome. Methods: Thirty one patients (24 men and 7 women, median age 39 years, range 19-67 years) with acute pancreatitis were investigated by contrast enhanced CT and echo enhanced ultrasound within 72 hours after admission. Echo enhanced ultrasound (with intravenous injection of 2.4 ml SonoVue, pulse inversion technique, mechanical index 0.1 to 0.2, Siemens Elegra) was performed following conventional ultrasound. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI). Correlations between CTSI and USSI and between USSI and clinical parameters were tested by Spearman's rank correlation coefficient. Results: A strong correlation was demonstrated between CTSI and USSI (r = 0.807, p,0.01). Ultrasound correlated with the following: the Ranson score (r = 0.401, p,0.05), C-reactive protein levels 48 hours after admission (r = 0.536, p,0.01), duration of hospitalisation (r = 0.422, p,0.05), and clinical outcome regarding morbidity, including local and systemic complications (r = 0.363, p,0.05). Based on CT findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detecting severe acute pancreatitis based on imaging criteria (Balthazar score D or E and/or presence of hypoperfusion compatible with necrosis and/or SI>3) were, respectively, 82% (95% CI 61 to 93), 89% (95% CI 57 to 98), 95% (95% CI 75 to 99), and 67% (95% CI 39 to 86). Conclusion: Echo enhanced ultrasound produces excellent results in the staging of acute pancreatitis severity. The procedure is cheaper and has fewer contraindications than CT. Further multicentre studies need to be performed before including the method in the diagnostic algorithm of patients with acute pancreatitis.

Contrast-enhanced ultrasound in the staging of acute pancreatitis

“…Our study confirms the value of CEUS in detecting pancreatic necroses and as a predictive indicator of the severity of an episode of acute pancreatitis. In our series a significant correlation between CT and CEUS was found for the CT severity index (r= 0.926), the extent of necrosis (r=0.893) and Balthazar grade (r=0.884), with similar results to those published by Rickes and colleagues [16].…”

“…For detecting necrosis there was discordance between our results and those of Rickes et al's study [16]. In their study, necrosis was detected with CEUS in all cases, while we missed three cases with mild necrosis (86% sensitivity).…”

“…Afterwards there is a progressive washout of contrast medium with loss of gland echogenicity [15]. A recent report showed that acute pancreatitis may be graded with CEUS with comparable results to contrast-enhanced CT, avoiding the drawbacks of iodinated contrast materials such as nephrotoxicity and idiosyncratic reactions [16]. Those authors proposed that CEUS could be an alternative imaging technique to CT, especially in cases when iodinated contrast medium injection is contraindicated.…”

Can Contrast-Enhanced Ultrasound Evaluate the Severity of Acute Pancreatitis?

“…Based on this, we assumed that in AP the necrotic region of the pancreatic tissues should present similar non-perfusion or hypoperfusion areas on CEUS, which may make it possible for CEUS to assess pancreatic tissue necrosis and the severity of pancreatitis. Rickes and Brocchi reported their experience in assessing the severity of AP with CEUS and achieved encouraging results [19,20]. The aim of our study was to investigate the ability of CEUS in the assessment of pancreatic necrosis and peripancreatic effusion and/or complications in AP, as well as its diagnostic accuracy in the evaluation of the severity of pancreatitis.…”

Diagnose eines Ileumkarzinoids mittels kontrastverstärkten Ultraschalls

“…Echosignalverstärker die diagnostischen Möglichkeiten des Ultraschalls deutlich erweitert werden. Mit dieser Methode sind beispielsweise Leber-und Pankreastumoren besser diagnostizier-und differenzierbar [12][13][14][15][16][17][18][19][20]. Bei Vorliegen einer Lebermetastasierung kann mit der Kontrastmittelsonographie anhand des Vaskularisationsverhaltens der Läsionen (hypo-oder hypervaskularisiert) ein Hinweis auf das Vorliegen von Absiedlungen eines Adenokarzinoms (wenig durchblutet) bzw.…”