Imaging Assessment of Etiology and Severity of Acute Pancreatitis

Bollen, M.D Thomas L

doi:10.3998/panc.2016.31

Cited by 5 publications

(6 citation statements)

References 120 publications

(222 reference statements)

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“…Gallstone pancreatitis accounts for approximately 40-70% of all cases of acute pancreatitis in the developed world, representing at least two-thirds of all cases when combined with alcohol abuse [1,3]. Given its prevalence in the pathophysiology of acute pancreatitis, detection of gallstone disease is of relative importance in the initial diagnostic evaluation of acute pancreatitis, especially given that radiographic evidence is often needed to fulfill clinical criteria to make the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…As described by the Revised Atlanta classification, acute pancreatitis is diagnosed by the fulfillment of at least two out of three of the following clinical criteria: epigastric abdominal pain, elevated lipase level (more than three times the upper limit of normal), and/or radiographic evidence of pancreatitis [1]. Computer tomography of the abdomen and pelvis (CTAP) is frequently the imaging modality of choice for establishing the radiographic evidence needed for diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

Froes¹,

Gosal²,

Singh³

et al. 2022

Cureus

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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. MethodsA 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). ResultsPatients 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. ConclusionPerforming AUS within 48 hours fol...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

Froes¹,

Gosal²,

Singh³

et al. 2022

Cureus

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“…Abdominal ultrasound (US) serves as a valuable tool, particularly in the initial phase of acute pancreatitis, aiding in assessing biliary stones as a potential cause and facilitating monitoring of pancreatic collections. However, its utility may be severely limited due to poor visibility [20].…”

Section: Imaging Modalities and Key Radiological Findings Indicating ...mentioning

confidence: 99%

“…While less frequently utilized than CT, magnetic resonance imaging (MRI) proves invaluable in specific scenarios. It is beneficial for evaluating patients with iodine allergies, characterizing collections, and assessing the pancreatic duct, especially in cases involving ductal disconnection [18,20]. Additionally, ERCP plays a significant role in identifying common bile duct stones in cases of acute biliary pancreatitis [20].…”

Section: Imaging Modalities and Key Radiological Findings Indicating ...mentioning

confidence: 99%

Radiological and Biochemical Parameters in Assessing Acute Pancreatitis Severity: A Comprehensive Review

Bikkumalla,

Chandak,

Reddy

et al. 2024

Cureus

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Acute pancreatitis is a dynamic inflammatory condition of the pancreas with a spectrum ranging from mild to severe. Early and accurate assessment of disease severity is crucial for guiding clinical management and improving patient outcomes. This comprehensive review explores the role of radiological and biochemical parameters in assessing the severity of acute pancreatitis. Radiological imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), play a pivotal role in identifying key features, such as pancreatic necrosis and peripancreatic fluid collections, indicative of severe disease. Additionally, serum markers such as amylase, lipase, and C-reactive protein (CRP) provide valuable prognostic information and aid in risk stratification. Integrating radiological and biochemical parameters allows for a multidimensional evaluation of disease severity, enabling clinicians to make informed decisions regarding patient management. Early identification of severe cases facilitates timely interventions, including intensive care monitoring, nutritional support, and potential surgical interventions. Despite significant advancements in the field, there remain areas for further research, including the validation of emerging imaging techniques and biomarkers and the exploration of personalized management approaches. Addressing these research gaps can enhance our understanding of acute pancreatitis and ultimately improve patient care and outcomes.

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“…Magnetic resonance cholangiopancreatography (MRCP) is considered the most reliable non-invasive technique that produces high-contrast and high-resolution images of the biliary tree and allows the evaluation of the solid organs. However, contraindications including patients with cardiac pacemakers, cerebral aneurysm clips, or claustrophobia added to that high cost and not readily available [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Validity of MDCT cholangiography in differentiating benign and malignant biliary obstruction

Alsowey

Salem

Amin

2021

Egypt J Radiol Nucl Med

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Background MDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Early tumor detection and staging of biliary cancer are key factors for a possible cure by surgical resection. Between December 2019 and October 2020, 69 patients with clinically suspected biliary obstruction were enrolled in the study, subjected to clinical assessment (full history taking and clinical examination) and imaging assessment by MDCT cholangiography. Our findings were correlated to standard reference examinations including operative/ERCP/biopsy and histopathology findings. Results The most affected age was between 60 and 70 years old, and males were more affected. The commonest clinical presentation was yellowish discoloration of the skin and sclera followed by biliary colic. Right hypochondrial tenderness was the main clinical finding on clinical examination. Our patients were categorized according to the etiology of biliary obstruction into 7 groups: malignant stricture 52.2% (36 patients), calcular 24.6% (17 patients), iatrogenic 5.8% (4 patients), portahepatis lesions 5.8% (4 patients), benign stricture 4.3% (3 patients), inflammatory 4.3% (3 patients), and congenital 1.4% (1 patient). The malignant group shows dominant mass, moderate biliary obstruction, and arterial and venous enhancement. The overall sensitivity was 94% for malignancy. Conclusion MDCT cholangiography is non-invasive, fast, and highly sensitive and specific in the diagnosis of different causes and levels of biliary obstruction and is useful in the characterization of the lesion in cases of malignant obstruction and differentiating it from benign stricture. It can be used as an effective alternative to ERCP or PTC.

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Imaging Assessment of Etiology and Severity of Acute Pancreatitis

Cited by 5 publications

References 120 publications

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

Radiological and Biochemical Parameters in Assessing Acute Pancreatitis Severity: A Comprehensive Review

Validity of MDCT cholangiography in differentiating benign and malignant biliary obstruction

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