The diffuse reduction in spleen density: an indicator of severe acute pancreatitis?

Abstract

We observed that acute pancreatitis (AP) was associated with diffuse reduction in spleen density (DROSD) in some patients. Furthermore, the condition of these patients was more serious, and the potential relationship between DROSD and structural and functional injury of the spleen remained unclear. Therefore, we performed a preliminary exploration of these factors. We analysed pertinent clinical data for AP patients with normal spleen density (control group) and for those with DROSD (reduction group) at the First Affiliated Hospital of Harbin Medical University (June 2013–June 2015). We measured the immunoglobulin M (IgM) B-cells of the AP patients and examined pancreatic and splenic tissues from AP rats with optical microscopy and TEM. The reduction group had a higher acute physiology and chronic health evaluation II (APACHE II) score, a longer length of stay (LOS) and lower serum calcium than the control group. The levels of triglycerides (TG) and total cholesterol (TC) did not differ significantly between the two groups. The percentage of IgM memory B-cells was significantly lower in the DROSD group than in the control group. TEM revealed that the spleen T-lymphocytes were normal in AP rats, but pyroptotic and necrotic spleen B-cells were observed in the severe AP rats. In AP, DROSD was an independent indicator of more severe conditions. Furthermore, spleen B-lymphocytes showed obvious damage at the cellular level, and the immunological function of the spleen was down-regulated when AP was associated with DROSD.

Diffuse Reduction of Spleen Density Is an Independent Predictor of Post-Operative Outcomes After Curative Gastrectomy in Gastric Cancer: A Multi-Center Study

“…Second, it has been reported that splenic volume increase is a surrogate marker of inflammation cells accumulation and associated with worse longterm survival (27,28). As mentioned in the previous literature, the reduction of spleen density in acute severe pancreatitis rats was related to the increase of spleen volume (7). There may be a correlation between the spleen density and the volume in human, which leads to spleen density associated with poor long-term prognosis.…”

“…It has been reported that spleen density reduction is associated with lipid metabolism (6). Some animal experiments show that DROSD is not related to lipid deposition but hemoperfusion (7). The rich blood flow of spleen can change physical density, thereby affecting its density value on CT (34,35).…”

“…First, spleen is an abdominal parenchymal organ of the body ( 21 ). AP patients with DROSD have downregulated immune function, and DROSD patients had more severe lymphocytes decreased than non-DROSD patients ( 7 ). It is worth noting that immune function were associated with favorable prognosis for gastric cancer patients ( 22 – 24 ).…”

“…Interestingly, the post-operative prognosis of these patients was more serious. Some scholars found that AP patients with DROSD had more severe immune dysfunction than without (7). The host immune system is relevant to cancer development and progression (8,9).…”

Hypointense Spleen Associated with Severe Acute Pancreatitis on MR Imaging

“…Recently, splenic density on CT is reported to decrease in patients with severe acute pancreatitis. 1 This CT finding may be induced by splenocyte reduction, which is a compensatory reaction to peripheral lymphocyte reduction, damaged B-lymphocytes, and fibroblast infiltration in the spleen. 1,2 The spleen shows hypointensity in the neonate on the T 1 - and T 2 -weighted MR images, whereas the signal intensity markedly increases by 8 months of age on the T 2 -weighted images in proportion to the development of white pulp and maturation of lymphocytic systems.…”