Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis

Tsuji, Yoshihisa; Takahashi, Naoki; Isoda, Hiroyoshi; Koizumi, Koji; Koyasu, Sho; Sekimoto, Miho; Imanaka, Yuichi; Yazumi, Shujiro; Asada, Masanori; Nishikawa, Yoshihiro; Yamamoto, Hiroshi; Kikuchi, Osamu; Yoshida, Tsukasa; Inokuma, Tetsuro; Katsushima, Shinji; Esaka, Naoki; Okano, Akihiro; Kawanami, Chiharu; Kakiuchi, Nobuyuki; Shiokawa, Masahiro; Kodama, Yuzo; Moriyama, Ichiro; Kajitani, Takafumi; Kinoshita, Yoshikazu; Chiba, Tsutomu

doi:10.1007/s00535-017-1330-5

Cited by 17 publications

(17 citation statements)

References 46 publications

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“…Therefore, we did not use the abovementioned clinical information as risk factors in combination with radiomics features to establish a predictive model. Pancreatic necrosis has been shown to be related to organ failure and severe pancreatitis in previous studies, and our study also shows that pancreatic necrosis is more common in the SAP group in both the training cohort and the validation cohort. Our ROIs contained necrotic regions, so we also did not include necrosis in the model.…”

Section: Discussionmentioning

confidence: 99%

Radiomics model of contrast‐enhanced MRI for early prediction of acute pancreatitis severity

Lin

Chen

et al. 2019

Magnetic Resonance Imaging

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Background Computed tomography (CT) or MR images may cause the severity of early acute pancreatitis (AP) to be underestimated. As an innovative image analysis method, radiomics may have potential clinical value in early prediction of AP severity. Purpose To develop a contrast‐enhanced (CE) MRI‐based radiomics model for the early prediction of AP severity. Study Type Retrospective. Subjects A total of 259 early AP patients were divided into two cohorts, a training cohort (99 nonsevere, 81 severe), and a validation cohort (43 nonsevere, 36 severe). Field Strength/Sequence 3.0T, T1‐weighted CE‐MRI. Assessment Radiomics features were extracted from the portal venous‐phase images. The "Boruta" algorithm was used for feature selection and a support vector machine model was established with optimal features. The MR severity index (MRSI), the Acute Physiology and Chronic Health Evaluation (APACHE) II, and the bedside index for severity in acute pancreatitis (BISAP) were calculated to predict the severity of AP. Statistical Tests Independent t‐test, Mann–Whitney U‐test, chi‐square test, Fisher's exact tests, Boruta algorithm, receiver operating characteristic analysis, DeLong test. Results Eleven potential features were chosen to develop the radiomics model. In the training cohort, the area under the curve (AUC) of the radiomics model, APACHE II, BISAP, and MRSI were 0.917, 0.750, 0.744, and 0.749, and the P value of AUC comparisons between the radiomics model and scoring systems were all less than 0.001. In the validation cohort, the AUC of the radiomics model, APACHE II, BISAP, and MRSI were 0.848, 0.725, 0.708, and 0.719, respectively, and the P value of AUC comparisons were 0.96 (radiomics vs. APACHE II), 0.40 (radiomics vs. BISAP), and 0.46 (radiomics vs. MRSI). Data Conclusion The radiomics model had good performance in the early prediction of AP severity. Level of Evidence: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:397–406.

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Section: Discussionmentioning

confidence: 99%

Radiomics model of contrast‐enhanced MRI for early prediction of acute pancreatitis severity

Lin

Chen

et al. 2019

Magnetic Resonance Imaging

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“…There are, however, publications that indicate the benefit of an early CT imaging, but not by the standard method but by using the CT perfusion option [56, 57]. CT perfusion allows the detection and quantification of early microvascular changes in tissues and may be a promising technique for predicting tissue viability.…”

Section: Discussionmentioning

confidence: 99%

Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease?

Pieńkowska

Gwoździewicz

Skrobisz

et al. 2019

Gastroenterology Research and Practice

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Background. The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods. 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results. Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions. Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.

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“…By contrast, trypsinogen‐2 and lipase are released during AP and mediate inflammation and autodigestion of pancreatic and peripancreatic tissues, explaining their ability to predict the risk of subsequent local complications. Although local perfusion disturbance is also an important mechanism of necrotizing pancreatitis, its detection requires perfusion CT that is not widely available in general clinical practice. The inverse association between age and local complications might be attributed to the reduced activation or activity of released trypsinogen with aging.…”

Section: Discussionmentioning

confidence: 99%

Urinary trypsinogen‐2 level and local complications of acute pancreatitis

Wang

Chen

et al. 2019

J of Gastro and Hepatol

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Background and Aim: Local complications of acute pancreatitis (AP) carry risks of morbidity/mortality. This study aimed to assess whether urinary trypsinogen-2 levels and Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission predicted subsequent local complications. Methods: One hundred and forty-four consecutive patients with AP were prospectively followed till 6 months after discharge. Urinary trypsinogen-2 levels were measured within 24 h of admission. Local complications (acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, and walled-off necrosis) were diagnosed by abdominal computed tomography. Cut-off for trypsinogen-2 level was assessed using receiver operating characteristic curve, and predictors of local complications were analyzed by logistic regression. Results: Thirty-seven (25.7%) patients developed local complications. Urinary trypsinogen-2 levels were significantly higher in patients with local complications compared with those without local complications (median [interquartile range], 3210 [620-9764.4] μg/L vs 627.3 [72.3-5895] μg/L, P = 0.006). Urinary trypsinogen-2 significantly outperformed BISAP score in predicting local complications (area under the receiver operating characteristic curve 0.65 [95% CI: 0.55-0.75] vs 0.48 [95% CI: 0.38-0.58], P = 0.005). At the optimal cut-off of 500 μg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of trypsinogen-2 level were 78.4%, 45.8%, 33.3%, and 86.0%, respectively. Urinary trypsinogen-2 level > 500 μg/L was an independent predictor of local complications (adjusted odds ratio, 3.72; 95% CI: 1.42-9.76; P = 0.007). By contrast, BISAP score ≥ 3 and pleural effusion predicted organ failure but not local complications. Conclusion: In a prospective cohort, urinary trypsinogen-2 level > 500 μg/L independently predicted local complications of AP.

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Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis

Abstract: Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .

Cited by 17 publications

References 46 publications

Radiomics model of contrast‐enhanced MRI for early prediction of acute pancreatitis severity

Radiomics model of contrast‐enhanced MRI for early prediction of acute pancreatitis severity

Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease?

Urinary trypsinogen‐2 level and local complications of acute pancreatitis

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