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Diffusion weighted MRI and neutrophil lymphocyte ratio non-invasively predict infection in pancreatic necrosis: a
Rommel Sandhyav1,2, Nihar Mohapatra2, Nikhil Agrawal2,3
1Department of HPB Surgery and Liver Transplantation, Aster RV Hospital, Bangalore, -560078, India.
Background:
Infected pancreatic necrosis (IPN) is a major determinant of mortality in acute pancreatitis (AP). Non-invasive diagnosis of IPN could guide the intervention in AP. We aimed to investigate the role of non-invasive methods like diffusion weighted magnetic resonance imaging (DW-MRI) and clinico-laboratory parameters as predictors of IPN.
Methods:
Prospective evaluation for predictors of IPN by diffusion restriction (DR) on DW-MRI and clinico-laboratory parameters was performed.
Results:
Out of 39 patients included, 31 were analysed after exclusion. Twenty-six (83.8%) patients had moderately severe AP, and the rest had severe disease. They were categorized into Group A: patients with documented infection after intervention (n = 17) and Group B: successfully managed without intervention or negative culture after intervention (n = 14). On univariate analysis, Group A had significantly more incidence of fever (P = 0.020), persistent unwellness (P = 0.003), elevated neutrophil count (P = 0.007), lymphocyte count (P = 0.007), neutrophil lymphocyte ratio (NLR) (P = 0.028), DR on DW-MRI (P = 0.001) and low apparent diffusion coefficient (ADC) (P = 0.086). Multivariate analysis revealed DR on DW-MRI (P = 0.004) and NLR (P = 0.035) as significant predictors of IPN, among other factors. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DW-MRI were 94.1%, 78.6%, 91.66%, and 84.21%, respectively. The area under curve of NLR on the ROC plot was 0.85 and the best cutoff was >3.5, with sensitivity, specificity, PPV, and NPV of 70.6%, 78.6%, 80%, and 68.7% respectively.
Conclusion:
DW-MRI and NLR are promising non-invasive tools for accurate prediction of IPN and hence can guide the need for intervention in acute pancreatitis.
Insights
Infected pancreatic necrosis (IPN) in acute pancreatitis (AP) can be predicted non-invasively using diffusion-weighted MRI (DW-MRI) and neutrophil-lymphocyte ratio (NLR). These tools can help determine the need for intervention in AP patients.
Area of Science:
- Radiology
- Gastroenterology
- Medical Diagnostics
Background:
- Infected pancreatic necrosis (IPN) significantly increases mortality in acute pancreatitis (AP).
- Accurate and timely diagnosis of IPN is crucial for guiding appropriate clinical management.
- Non-invasive diagnostic methods are needed to avoid invasive procedures in AP patients.
Purpose of the Study:
- To evaluate diffusion-weighted magnetic resonance imaging (DW-MRI) and clinico-laboratory parameters as non-invasive predictors of IPN.
- To assess the diagnostic accuracy of DW-MRI and neutrophil-lymphocyte ratio (NLR) in identifying IPN.
Main Methods:
- Prospective study involving patients with acute pancreatitis.
- Diffusion restriction (DR) on DW-MRI and various clinico-laboratory parameters were assessed.
- Statistical analyses, including univariate, multivariate, and ROC curve analyses, were performed.
Main Results:
- Multivariate analysis identified DR on DW-MRI and NLR as significant independent predictors of IPN.
- DW-MRI demonstrated high sensitivity (94.1%) and specificity (78.6%) for IPN prediction.
- NLR showed an area under the ROC curve of 0.85, with a best cutoff >3.5.
Conclusions:
- DW-MRI and NLR are effective non-invasive tools for predicting IPN in acute pancreatitis.
- These methods can aid clinicians in deciding the necessity of interventions for AP.
- Non-invasive prediction of IPN can optimize patient management and potentially reduce mortality.
