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Early diagnosis and severity assessment of acute pancreatitis (AP) using MR elastography (MRE) with spin-echo
Yu Shi1, Ying Liu1, Yan-Qing Liu1
1Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
Purpose:
To evaluate the accuracy of magnetic resonance elastography (MRE) in comparison to contrast-enhanced computed tomography (CE-CT) for early diagnosis and prediction of severity in acute pancreatitis (AP).
Materials And Methods:
This cross-sectional prospective study included 76 patients with suspected AP who underwent both CE-CT and 3.0T MRE within 24 hours of hospital admission. Pancreatic stiffness, CT severity index (CTSI), Acute Physiology and Chronic Health Evaluation (APACHE)-II, and Bedside Index for Severity in AP (BISAP) scores were comparatively evaluated using data from the first 24 hours of admission, and diagnosis and severity of AP were confirmed according to the revised Atlanta Classification (2012). The accuracy of MRE for predicting disease severity was compared with that of CE-CT and the clinical scoring systems using area under the receiver-operating curve (AUC) analysis.
Results:
AP was confirmed in 56/76 patients (73.7%). Pancreatic stiffness values of >1.47 kPa showed significantly better diagnostic performance than CE-CT (AUC: 0.993 vs. 0.818, P < 0.001) along with greater sensitivity (96.4% vs. 78.6%, P = 0.006) and accuracy (96.1% vs. 81.6%, P = 0.007). Ten patients (10/76; 13.2%) had clinically severe AP. The accuracy of pancreatic stiffness >2.47 kPa was comparable to that of the CTSI, APACHE-II and BISAP scores for predicting severe AP (accuracy = 85.5%, 75.0%, 88.2%, and 78.9%, respectively). The pairwise comparisons were not significant after Bonferroni correction (P < 0.008 [0.05/6]), with P values of 0.008 (MRE vs. CTSI), 0.823 (MRE vs. APACHE-II) and 0.414 (MRE vs. BISAP).
Conclusion:
Early MRE is a useful, noninvasive method for both diagnosis and early severity assessment of AP. We recommend MRE at hospital admission for initial evaluation of AP.
Level Of Evidence:
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1311-1319.
Insights
Magnetic resonance elastography (MRE) accurately diagnoses acute pancreatitis (AP) and predicts its severity. This noninvasive method shows superior performance compared to contrast-enhanced computed tomography (CE-CT) for early AP evaluation.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Acute pancreatitis (AP) diagnosis and severity assessment are critical for patient management.
- Current diagnostic tools like contrast-enhanced computed tomography (CE-CT) have limitations in early prediction.
- Noninvasive imaging modalities are sought for improved early evaluation of AP.
Purpose of the Study:
- To compare the accuracy of magnetic resonance elastography (MRE) with CE-CT for diagnosing AP.
- To evaluate MRE's ability to predict AP severity compared to CE-CT and clinical scoring systems.
Main Methods:
- A prospective cross-sectional study involving 76 patients with suspected AP.
- Patients underwent both CE-CT and 3.0T MRE within 24 hours of admission.
- Diagnostic accuracy and severity prediction were assessed using receiver-operating curve (AUC) analysis.
Main Results:
- MRE demonstrated superior diagnostic performance for AP compared to CE-CT (AUC 0.993 vs. 0.818).
- MRE showed higher sensitivity (96.4%) and accuracy (96.1%) in diagnosing AP.
- MRE's accuracy in predicting severe AP was comparable to established clinical scoring systems (CTSI, APACHE-II, BISAP).
Conclusions:
- Early MRE is a valuable, noninvasive tool for diagnosing AP.
- MRE effectively assesses AP severity at hospital admission.
- MRE is recommended for the initial evaluation of patients with suspected AP.
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