Early-phase vascular involvement is associated with acute pancreatitis severity: a magnetic resonance imaging study

Abstract

Background: Although a number of studies have reported on the vascular abnormalities detected by magnetic resonance imaging (MRI) in patients with late-phase acute pancreatitis (AP), few have studied those occurring in the early phase of the disease. The aim of this research was to investigate the MRI findings of early vascular abnormalities in AP and to analyze the correlation of the prevalence of vascular involvement with the severity of AP based on the MR severity index (MRSI) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores.Methods: A retrospective analysis was conducted of 301 consecutive AP patients who were admitted to our institution between March 2013 and June 2019. All patients underwent initial MRI during the early phase of pancreatitis and one or more repeat MRI scans in the late phase. Peripancreatic vascular conditions and pancreatitis were assessed using T1-/T2-weighted imaging and dynamic-enhanced MRI. The association between the prevalence of vascular involvement and AP severity graded according to the MRSI or APACHE II score was analyzed using Spearman's rank correlation.Results: Among 301 AP patients, 75 (24.9%) had at least one MRI-detected vascular abnormality. Overall, vascular involvement on MRI was higher in necrotizing pancreatitis than in edematous pancreatitis [43.2% (54/125) vs. 11.9% (21/176), χ 2 =38.2, P<0.001]. In the early phase of AP, the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis was 24.9% (75/301), 22.3% (67/301), and 19.9% (60/301), respectively. Splenic vein phlebitis was seen on initial MRI in 55.6% (15/27) of patients who had splenic vein thrombosis on repeat MRI. The MRSI scores showed that the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis, respectively, was correlated with the severity of pancreatitis (r=0.532, 0.487, and 0.456; all P<0.01). The APACHE II scores showed that the prevalence of MRI-detected vascular involvement was significantly correlated with AP severity (r=0.335, P<0.05).Conclusions: Vascular abnormalities, including splenic vein phlebitis and splenic arterial arteritis, are commonly seen on MRI in patients with early-phase AP, and they may be supplementary indicators that can reflect the severity of pancreatitis.

Early prediction of acute pancreatitis severity based on changes in pancreatic and peripancreatic computed tomography radiomics nomogram

“…Many studies have explored different aspects of AP using medical imaging. Jiang et al (12) reported that patients with early-phase AP frequently had vascular anomalies on magnetic resonance imaging (MRI), such as splenic vein phlebitis and splenic artery arteritis, which may serve as additional markers for pancreatitis severity. According to Peng et al (13), pleural effusion and pulmonary consolidation are associated with AP severity.…”

Computed tomography characteristics of acute pancreatitis based on different etiologies at different onset times: a retrospective cross-sectional study

“…However, Zhou et al ( 32 ) demonstrated that extrapancreatic inflammation on CT scores have weak positive correlations with the APACHE II score. In addition, Peng et al ( 44 ) reported that the pleural effusion volume was correlated with the APACHE II score, and Jiang et al ( 45 ) found a significant correlation between the incidence of vascular involvement and AP severity on the basis of APACHE II score. In our study, the MCTSI score had a positive correlation with the RAC and APACHE II score.…”

Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

“…In a retrospective analysis including 301 AP patients, MRI revealed that 24.9% exhibited at least one peripancreatic vascular abnormality related to AP, and the incidence of peripancreatic vascular involvement was notably more pronounced in necrotizing pancreatitis compared to edematous pancreatitis[ 76 ]. The common manifestations of early AP on MRI were splenic vein phlebitis and splenic artery involvement/arteritis, and 6.3% of the patients had splenic artery arteritis complicated with hemorrhage in the early phase of AP[ 76 ].…”