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Early-phase vascular involvement is associated with acute pancreatitis severity: a magnetic resonance imaging study
Zhi-Qiong Jiang1, Bo Xiao2,3, Xiao-Ming Zhang2
1Department of Geratology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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), χ2=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.
Insights
Early magnetic resonance imaging (MRI) reveals common vascular abnormalities in acute pancreatitis (AP). These findings, including splenic vein phlebitis and splenic arterial arteritis, correlate with disease severity, aiding in patient assessment.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Medicine
Background:
- Limited research exists on early-phase acute pancreatitis (AP) vascular abnormalities detected by MRI.
- Previous studies focused on late-phase AP vascular changes.
Purpose of the Study:
- Investigate early-phase AP vascular abnormalities using MRI.
- Analyze the correlation between vascular involvement prevalence and AP severity using MR severity index (MRSI) and APACHE II scores.
Main Methods:
- Retrospective analysis of 301 AP patients undergoing initial and repeat MRI scans.
- Assessment of peripancreatic vascular conditions and pancreatitis using T1-/T2-weighted and dynamic-enhanced MRI.
- Spearman's rank correlation used to analyze the association between vascular involvement and AP severity.
Main Results:
- 75 (24.9%) patients exhibited MRI-detected vascular abnormalities.
- Vascular involvement was significantly higher in necrotizing AP (43.2%) versus edematous AP (11.9%).
- Early phase prevalence: splenic vein phlebitis (24.9%), portal vein phlebitis (22.3%), splenic arterial arteritis (19.9%).
- Vascular abnormalities correlated significantly with MRSI and APACHE II scores.
Conclusions:
- Vascular abnormalities are common in early-phase AP on MRI.
- Findings like splenic vein phlebitis and splenic arterial arteritis may serve as supplementary indicators of pancreatitis severity.
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