Diagnostic Accuracy of Transabdominal Ultrasound in Chronic Pancreatitis

Abstract

The performance of transabdominal ultrasound (US) in chronic pancreatitis (CP) following the advances in US technology made during recent decades has not been explored. Our aim in this prospective study was to evaluate the diagnostic accuracy of modern abdominal US compared with the Mayo score in CP. One hundred thirty-four patients referred for suspected CP were included in the study. Fifty-four patients were assigned the diagnosis CP. After inclusion, transabdominal US was performed. Ductal features (calculi, dilations and caliber variations, side-branch dilations and hyper-echoic duct wall margins) and parenchymal features (calcifications, cysts, hyper-echoic foci, stranding, lobulation and honeycombing) were recorded. Features were counted and scored according to a weighting system defined at the international consensus meeting in Rosemont, Illinois (Rosemont score). Diagnostic performance indices (95% confidence interval) of US were calculated: The unweighted count of features had a sensitivity of 0.69 (0.54-0.80) and specificity of 0.97 (0.90-1). The Rosemont score had a sensitivity of 0.81 (0.69-0.91) and specificity of 0.97 (0.90-1). Exocrine pancreatic failure was most pronounced in Rosemont groups I and II (p < 0.001). We conclude that using both unweighted and weighted scores, the diagnostic accuracy of modern transabdominal US is good. The extent of pancreatic changes detected by the method is correlated with exocrine pancreatic function.

Good Agreement Between Transabdominal and Endoscopic Ultrasound of the Pancreas in Chronic Pancreatitis

“…We previously demonstrated the inferiority of EUS in detecting calcifications compared to CT [11]. We used CT as the reference standard for this criterion.…”

“…Due to reported limitations in the interobserver reproducibility of this score [20], many prefer to use an unweighted evaluation [1,2]. In our late study weighting of the criteria improved the accuracy [11]. There is no dedicated score for US features in CP.…”

“…Advances in ultrasound technology may have improved diagnostic performance [9,10]. We recently evaluated the updated diagnostic performance of US in CP and found a sensitivity of 81 % and specificity of 97 % [11].…”

“…These factors explain the inferior quality of US compared to EUS. However, with optimal scanning conditions, high-quality images of the pancreas can be achieved and scanning of the pancreas with high-frequency probes is possible from the external position [11]. Disadvantages of EUS are the invasive character of the procedure and the long learning curve for operators.…”

Comparability of size measurements of the pancreas in magnetic resonance imaging and transabdominal ultrasound

“…Validity of different imaging modalities has been assessed for cystic (Lee et al, 2015;Maimone et al, 2010) and solid lesions (Tummala, Junaidi, & Agarwal, 2011;Vukobrat-Bijedic et al, 2014) of the pancreas but there is still a lack of studies comparing the morphology and size of the anatomic segments of the pancreas, particularly for US. Due to advances in US technology and improved imaging quality this technique becomes more relevant for diagnostic and therapeutic strategies (Engjom et al, 2017;Lerch et al, 1992;Poza-Cordon & Ripolles-Gonzalez, 2014;Sun et al, 2017). Therefore, a comparison with high resolution imaging methods such as CT or MRI with US is justified.…”