CT and MRI in the diagnosis of the phase course of necrotizing pancreatitis (literature review)
https://doi.org/10.24835/1607-0763-1110
Abstract
Acute pancreatitis is one of the most common acute conditions in abdominal cavity with a broad spectrum of clinical symptoms, which range in severity from mild interstitial inflammation to severe forms with significant regional and systemic complications. Despite overall progress in treatment methods and critical care of the acute pancreatitis, this condition remains to be associated with a high mortality rate. Contrast-enhanced CT has been the golden standard in the diagnosis of the acute pancreatitis for a long time, but despite that there’s still a certain degree of inaccuracy in terminology, pertinent to both the literature and the guidelines, which in turn impacts treatment and prognosis. This work is dedicated to the radiological terminology and classification of the characteristic findings in the acute pancreatitis and necrotizing pancreatitis. Recommendations and indications for use of the CT and MRI has been discussed, as well as their methodology. The provisions of the review are illustrated by CT and MRI images of the most striking and significant changes in the framework of the disease from the authors' archive for greater clarity.
The main goal of this study is to consolidate data found in both foreign and domestic research in order to form a comprehensive understanding of development stages of acute pancreatitis. This is mainly achieved by their radiologic characterization, as well as possible complications.
About the Authors
A. V. Arablinskii
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Competing Interests:
Russian Federation
Andrey V. Arablinskii – Doct. of Sci. (Med.), Professor of the Department of Radiology and Radiotherapy
119991, Moscow, Trubetskaya str., 8, bld. 2
Competing Interests:
The authors declare no conflict of interest.
M. Y. Titov
I.M. Sechenov First Moscow State Medical University (Sechenov University); S.P. Botkin City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Mikhail Yu. Titov – graduate student, Department of Radiology and Radiotherapy of Institute of Clinical medicine named after N.V. Sklifosovskiy of the First Moscow State Medical University (Sechenov University); doctor-radiologist Department of Radiation Diagnostics of the S.P. Botkin City Clinical Hospital
+7-926-721-02-91
125284, Moscow, 2nd Botkinsky pr., 5
Competing Interests:
The authors declare no conflict of interest.
References
1. Amy Y.X., Marianne L.Y., Landy M.W. et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol. Hepatol. 2016; 1 (1): 45–55. http://doi.org/10.1016/S2468-1253(16)30004-8
2. Petrov M.S., Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat. Rev. Gastroenterol. Hepatol. 2019; 16 (3): 175–184. http://doi.org/10.1038/s41575-018-0087-5
3. Li C.L., Jiang M., Pan C.Q. et al. The global, regional, and national burden of acute pancreatitis in 204 countries and territories, 1990–2019. BMC Gastroenterol. 2021; 21 (1): 332. http://doi.org/10.1186/s12876-021-01906-2
4. Savelyev V.S., Filimonov M.I., Burnevich S.Z. Acute pancreatitis. National Manual of Surgery. M., 2009; Vol. 2: 196–229. (In Russian)
5. Wolfgang H., Hana A. Therapie der akutennekrotisierenden Pankreatitis. Internist (Berl.). 2019; 60 (3): 226–234. http://doi.org/10.1007/s00108-019-0558-y
6. Guru T., Daniel R.J., Hjalmar C. van S. et al. Current Concepts in Severe Acute and Necrotizing Pancreatitis: An Evidence-Based Approach. Gastroenterology. 2019; 156 (7): 1994–2007.e3. http://doi.org/10.1053/j.gastro.2019.01.269
7. Shabunin A.V., Arablinsky A.V., Bedin V.V., Grekov D.N., Shikov D.V., Lukin A.Ju., Tavobilov M.M., Sidorova Ju.V. Evaluation the role of dynamic contrast enhancement computed tomography (DCECT) and magnetic resonance tomography (MRI) as a prognostic indicator for various treatment of acute necrotizing pancreatitis. Medical visualization. 2009; 1: 35–49. (In Russian)
8. Shabunin A.V., Arablinskii A.V., Lukin A.Yu., Shikov D.V., Sidorova Yu.V. Pancreatic necrosis. Diagnosis and treatment. Moscow: GEOTAR Publishing House, 2014. 96 p. (In Russian)
9. Singh A.K., Samanta J., Shukla J. et al. Impact of Different Patterns of Organ Failure on Mortality in Acute Necrotizing Pancreatitis. Pancreas. 2021; 50 (7): 1030–1036. http://doi.org/10.1097/MPA.0000000000001880
10. Bradley E.L. 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch. Surg. 1993; 128 (5): 586–590. http://doi.org/10.1001/archsurg.1993.01420170122019
11. Banks P.A., Bollen T.L., Dervenis C. et al.; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62 (1): 102–111. http://doi.org/10.1136/gutjnl-2012-302779
12. Revishvili A.Sh., Kubyshkin V.A., Zatevakhin I.I. et al.; Russian Society of Surgeons. National Clinical guidelines: Acute pancreatitis (2020). Available on the website of the Russian Society of Surgeons: http://общество-хирургов.рф/stranica-pravlenija/klinicheskie-rekomendaci/urgentnaja-abdominalnaja-hirurgija/ostryi-pankreatitversija-sentjabr-2020.html? (In Russian)
13. Baranov E.V., Schott V.A., Zhura A.V. Complications of pancreatitis: studies-method. manual. Мinsk: BSMU, 2015. (In Russian)
14. Rocha A.P.C., Schawkat K., Mortele K.J. Imaging guidelines for acute pancreatitis: when and when not to image. Abdom. Radiol. (NY). 2020; 45 (5): 1338–1349. http://doi.org/10.1007/s00261-019-02319-2
15. Kothari S., Kalinowski M., Kobeszko M., Almouradi T. Computed tomography scan imaging in diagnosing acute uncom-plicated pancreatitis: Usefulness vs cost. Wld J. Gastroenterol. 2019; 25 (9): 1080–1087. http://doi.org/10.3748/wjg.v25.i9.1080
16. Arablinskii A.V., Rumer V.B., Sidorova Yu.V. Emergency computed tomography in the clinic of abdominal surgery. Moscow Surgical Journal. 2016; 4 (50): 12–19. (In Russian)
17. Porter K.K., Cason D.E., Morgan D.E. Acute Pancreatitis: How Can MR Imaging Help. Magn. Reson. Imaging Clin. N. Am. 2018; 26 (3): 439–450. http://doi.org/10.1016/j.mric.2018.03.011
18. Balthazar E.J. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002; 223 (3): 603–613. http://doi.org/10.1148/radiol.2233010680
19. Mortele K.J., Wiesner W., Intrriere L. et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. Am. J. Roentgenol. 2004; 183 (5): 1261–1265. http://doi.org/10.2214/ajr.183.5.1831261
20. Kaminskiy M.N., Rakhimova S.N., Konovalov V.A. Experience in the implementation of a modified step-up approach in the treatment of infected pancreatic necrosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 91–100. https://doi.org/10.16931/10.16931/1995-5464.2021-2-91-100 (In Russian)
21. Meyrignac O., Lagarde S., Bournet B. et al. Acute pancreatitis: extrapancreatic necrosis volume as early predictor of severity. Radiology. 2015; 276 (1): 119–128. http://doi.org/10.1148/radiol.15141494
22. Vikesh K.S., Thomas L.B., Bechien U.W. An assessment of the severity of interstitial pancreatitis. Clin. Gastroenterol. Hepatol. 2011; 9 (12): 1098–1103. http://doi.org/10.1016/j.cgh.2011.08.026
23. Ruedi F.T. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. 2012; 262 (3): 751–764. http://doi.org/10.1148/radiol.11110947
24. van Santvoort H.C., Besselink M.G., Bakker O.J. et al.A step-up approach or open necrosectomy for necrotizing pancreatitis. N. Engl. J. Med. 2010; 362 (16): 1491–502. http://doi.org/10.1056/NEJMoa0908821
25. Sakorafas G.H., Tsiotos G.G., Sarr M.G. Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under-appreciated entity. J. Am. Coll. Surg. 1999; 188 (6): 643–648. http://doi.org/10.1016/s1072-7515(99)00045-9
26. Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am. J. Gastroenterol. 2006; 101 (10): 2379–2400. http://doi.org/10.1111/j.1572-0241.2006.00856.x
27. Timmerhuis H.C., van Dijk S.M., Verdonk RC. et al.; Dutch Pancreatitis Study Group. Various modalities accurate in diagnosing a disrupted or disconnected pancreatic duct in acute pancreatitis: a systematic review. Dig. Dis. Sci. 2021; 66 (5): 1415–1424. http://doi.org/10.1007/s10620-020-06413-0
28. Shefer А.V., Belykh E.N. Staged treatment of acute necrotizing pancreatitis given the configuration of pancreatic necrosis (case report). Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 61–67. https://doi.org/10.16931/10.16931/1995-5464.2021-2-61-67 (In Russian)
29. Kotelnikova L.P., Plaksin S.A., Burnyshev I.G., Trushnikov D.V. Predictors for external and internal pancreatic fistulas after pancreatic necrosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 39–49. https://doi.org/10.16931/10.16931/1995-5464.2021-2-39-49 (In Russian)
30. Korymasov E.A., Khoroshilov M.Yu. “Fulminant” acute pancreatitis: diagnosis, prognosis, treatment. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 50–59. https://doi.org/10.16931/10.16931/1995-5464.2021-2-50-60 (In Russian)
31. Dyuzheva T.G., Shefer A.V., Dzhus E.V., Tokarev M.V., Stepanchenko A.P., Galperin E.I. Diagnosis of pancreatic duct disruption in acute pancreatitis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 15–24. https://doi.org/10.16931/10.16931/1995-5464.2021-2-15-24 (In Russian)
32. Galperin E.I., Dyuzheva T.G., Shefer A.V., Kotovskiy A.E., Semenenko I.A., Mudryak D.L. Early interventions for disconnected pancreatic duct syndrome in acute pancreatitis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2021; 26 (2): 25–31. https://doi.org/10.16931/1995-5464.2021-2-25-31 (In Russian)
33. Binit S., Kalpana B., Yashwant P., Ankur A. Imaging lexicon for acute pancreatitis: 2012 Atlanta Classification revisited. Gastroenterol. Rep. (Oxf.). 2016; 4 (1): 16–23. Published online 2015 Jul 27. https://doi.org/10.1093/gastro/gov036
34. Alvi A.R., Sheikh G.M., Kazim S.F. Delayed surgical therapy reduces mortality in patients with acute necrotizing pancreatitis. J. Pakistan Med. Assoc. 2011; 61 (10): 973.
35. Büchler M.W., Gloor B., Müller C.A. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann. Surg. 2000; 232 (5): 619.
36. Vege S.S., Gardner T.B., Chari S.T. et al. Low mortality and high morbidity in severe acute pancreatitis without organ failure: a case for revising the Atlanta classification to include “moderately severe acute pancreatitis”. Am. J. Gastroenterol. 2009; 104 (3): 710–715. http://doi.org/10.1038/ajg.2008.77
37. Bollen T.L., Singh V.K., Maurer R. et al. Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis. Am. J. Roentgenol. 2011; 197: 386–392.
38. Arablinskii A.V., Sidorova Yu.V., Shabunin A.V., Shikov D.V., Bedin B.V., Lukin A.Yu. Acute pancreatitis: some issues of diagnosis and treatment. Journal of Diagnostic and Interventional Radiology. 2011; 5 (2): 15–26. (In Russian)
39. 39 Arablinskii A.V., Shabunin A.V., Sidorova Yu.V., Lukin A.Yu., Bedin V.V., Shikov D.V., Possibilities of CT and MRI in diagnostics, dynamic observation and determination of tactics of treatment of patients with acute pancreatitis. Russian Electronic Journal of Radiology. 2013; 3 (4): 66–75. (In Russian)
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Arablinskii A.V., Titov M.Y. CT and MRI in the diagnosis of the phase course of necrotizing pancreatitis (literature review). Medical Visualization. 2022;26(2):139-153. (In Russ.) https://doi.org/10.24835/1607-0763-1110
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