Ultrasonographic Findings of the Pancreas in Cats with Elevated Serum Pancreatic Lipase Immunoreactivity

Abstract

Background: Pancreatitis is a common disease in cats that is difficult to diagnose. Hypothesis/Objectives: To determine the sensitivity and specificity of ultrasonographic changes of the pancreas with serum feline pancreatic lipase immunoreactivity (fPLI) as the standard for diagnosis of pancreatitis.Animals: 35 cats with clinical signs consistent with pancreatitis with an abdominal ultrasound examination and serum fPLI concentration measured within 3 days of the ultrasound.Methods: Retrospective study: Pancreatic thickness, pancreatic margination, pancreatic echogenicity, and peripancreatic fat echogenicity were evaluated. Sensitivity and specificity were calculated with an elevated serum fPLI concentration indicative of pancreatitis as the standard for diagnosis.Results: Serum fPLI was elevated and diagnostic for pancreatitis in 19 of 35 cats. The single ultrasound characteristic with the highest sensitivity was hyperechoic peripancreatic fat at 68% (95% confidence interval = 44-87%), indicating a moderate probability that cats with pancreatitis will have this abnormality on ultrasonographic examination. Specificity was >90% for each of increased pancreatic thickness, abnormal pancreatic margin, and hyperechoic peripancreatic fat. The sensitivity and specificity of ultrasound were 84% (95% confidence interval = 60-97%) and 75% (95% confidence interval = 48-93%), respectively, in cats with elevated serum fPLI indicative of pancreatitis.Conclusions and Clinical Importance: The presence of a thick left limb of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat in cats with appropriate clinical signs and elevated serum fPLI are highly supportive of pancreatitis.

A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome

“…Admittedly, a definitive diagnosis of FP is not commonly achieved, because procurement of biopsy samples for histopathology is seldom carried out in most clinical settings . Although abdominal sonography lacks sensitivity (ranging from 11% to 84%, depending on disease severity, ultrasound technology and the radiologist's expertise), it is fairly specific for diagnosing pancreatitis . Moreover, when the accuracy of sonography for detecting pancreatitis is assessed against pancreatic‐specific lipase assays, specificity may spuriously decrease, because these assays are relatively insensitive in mild to moderate disease .…”

“…The sonographic diagnosis of pancreatitis was based on presence of >2 of the following findings: pancreatomegaly, pancreatic echogenicity and echotexture abnormalities, irregular pancreatic contours, surrounding hyperechoic mesentery, peri‐pancreatic fluid accumulation, pancreatic mineralization, and irregular or abnormal pancreatic duct dilatation . Acute kidney injury (AKI) and chronic kidney disease were diagnosed based on the International Renal Interest Society guidelines (http://iris-kidney.com/guidelines/staging.html) and grading system (http://www.iris-kidney.com/pdf/grading-of-acute-kidney-injury.pdf).…”

“…Owing to the nonspecific signs of acute (AP) and chronic (CP) pancreatitis, overlapping with those of many other diseases, the diagnosis of FP is based on compatible clinical signs and corroborative laboratory and imaging findings . Ultrasonographic changes in pancreatic echogenicity and size, increased peri‐pancreatic echogenicity, free or peri‐pancreatic abdominal fluid accumulation, and dilated pancreatic and bile ducts are suggestive of pancreatic inflammation . Concurrent increases in serum pancreatic lipase activity, including 1,2‐o‐dilauryl‐rac‐glycerol‐glutaric acid‐(6′‐methylresorufin)‐ester (DGGR) lipase or feline pancreatic lipase immunoreactivity (fPLI) are supportive of FP .…”

Feline Diabetes Mellitus

“…Findings of acute and chronic pancreatitis may overlap, because cats may have acute or chronic disease. The most useful criteria appear to be thickening of the pancreas, severely irregular pancreatic margins, and hyperechoic peripancreatic fat (Williams et al, 2013). It is important to note, however, that the pancreas may also look unremarkable in cats with pancreatitis and that ultrasonographic findings may not correlate with clinical disease.…”

Diagnosis of pancreatic disease in feline platynosomosis

“…The procedure for pancreatic measurements and grading followed the criteria 155 recommended by Williams et al (2013). (13) Immediately after euthanasia a gross post-mortem examination was conducted.…”