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Spleen and splenic vascular involvement in acute pancreatitis: an MRI study
Chao-Lian Xie1, Mao Zhang2, Yong Chen1
1Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China.
Background:
To investigate the spleen and splenic vascular involvement in acute pancreatitis (AP) and their correlations with the severity of AP using magnetic resonance imaging (MRI).
Methods:
MRI of 239 patients with AP was retrospectively reviewed to assess splenic and splenic vascular complications, and the severity of AP. The severity of AP was graded by the MRI severity index (MRSI) and the New Revised Classification of AP 2012. The intravoxel incoherent motion (IVIM) parameters (D, D*, and f) of spleen were measured. Thirty-five subjects without pancreatic and splenic disorders were enrolled as controls for IVIM parameters.
Results:
Among the 239 patients with AP, splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%) and arteritis (4.2%) were observed. Splenic vascular involvement was positively correlated with the severity of AP based on both the MRSI and the New Revised Classification of AP 2012 (P<0.05). In the control and AP groups, the splenic f values were (0.164±0.074) vs. (0.210±0.095) (P=0.023) respectively. In AP patients with and without splenomegaly, f = (0.240±0.091) vs. (0.203±0.095) (P<0.001).
Conclusions:
Splenic vascular involvement and splenomegaly were common in AP. The vascular involvement was associated with the severity of AP. This complication should be considered when severity and prognosis of AP are assessed. Quantitative analysis of the spleen with IVIM might be a useful imaging biomarker for splenic perfusion changes in AP, especially in those with splenomegaly.
Insights
Splenic complications like splenomegaly and vascular issues are common in acute pancreatitis (AP) and linked to its severity. Intravoxel incoherent motion (IVIM) MRI may help assess these splenic changes.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Medicine
Background:
- Acute pancreatitis (AP) can affect the spleen and its vasculature.
- Assessing splenic involvement is crucial for understanding AP severity and prognosis.
Purpose of the Study:
- To investigate splenic and splenic vascular involvement in AP using MRI.
- To correlate these findings with AP severity.
- To evaluate intravoxel incoherent motion (IVIM) parameters for splenic assessment.
Main Methods:
- Retrospective MRI review of 239 AP patients.
- Assessment of splenic and vascular complications and AP severity (MRSI, 2012 Classification).
- Measurement of splenic IVIM parameters (D, D*, f) and comparison with 35 controls.
Main Results:
- Splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%), and arteritis (4.2%) were observed in AP patients.
- Splenic vascular involvement correlated positively with AP severity (P<0.05).
- Splenic f-values were significantly higher in AP patients compared to controls (0.210 vs. 0.164, P=0.023) and in AP patients with splenomegaly (0.240 vs. 0.203, P<0.001).
Conclusions:
- Splenic vascular involvement and splenomegaly are frequent in AP and associated with disease severity.
- These splenic complications should be considered in AP assessment and prognosis.
- Quantitative spleen analysis using IVIM MRI shows potential as a biomarker for splenic perfusion changes in AP, particularly with splenomegaly.
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