Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2014 Vol. 22 No 1

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.1.58   |  

Y.S. VINNIK, S.S. DUNAEVSKAYA, D.A. ANTUFRIEVA

POSSIBILITY OF THE CURRENT METHODS OF VISUALIZATION AT SEVERE ACUTE PANCREATITIS

SBEE HPE Krasnoyarsk State Medical
University named after prof. V.F.
Voyno-Yasenetsky
The Russian Federation

Objectives. To determine effectiveness of application of ultrasonography (US), CT-angiography and magnetic resonance imaging (MRI) in diagnosis of severe acute pancreatitis in the enzymatic stage of the disease.
Methods. 30 patients with diagnosis of a severe acute pancreatitis in the enzymatic stage of the disease have been studied. The age of patients varied between 23 and 76 years. The patients were carried out US of the abdominal cavity organs, CT-angiography with contrast bolus and MRI with contrast in the period between 24 and 48 hour after hospitalization. All patients (abdominal organs) were scanned by B-mode Ultrasonography with Aloka product (model SSD-3500) Ultrasound diagnostic system equipped with 3,5 MHz transducer. As the peculiarity of the conduction of CT-angiography is the performance of a 3-phase scan: native (contrast free), arterial and venous. The delay of scanning start for obtaining the arterial phase was determined automatically according to the program Bolus tracking.
A series of images in the coronal and axial planes in T1VI and T2VI has been performed in MRI and MR cholangiography. The recommended dosage of MAGNEVIST injection is 0,2 ml/kg.
To assess diagnostic methods of efficacy the following parameters have been calculated: sensitivity, specificity, accuracy, prognostic value of a positive result (PVPR), prognostic value of a negative result (PVNR).
Results. While determining efficacy of the visualization methods at severe acute pancreatitis US sensitivity was made 50%, specificity 20,0%, accuracy 37,1%, PVPR 45,5%, PVNR 23,1%. While establishing MRI effectiveness sensitivity made up 86,9%, specificity 100%%, accuracy 90%, PVPR 100%, PVNR 70%.
Conclusions. CT-angiography and MRI revealed no reliable diagnostic distinctions. The more clearly visualization of infiltration sites and collection of fluid in the peritoneal cavity are considered to be the advantages of MRI with contrast. Ultrasonography appears to be not able to provide the clearly visualization of lesion volume, however, is considered to be relevant as a screening method.

Keywords: acute pancreatitis, diagnostics, visualization, severe course
p. 58 62 of the original issue
References
  1. Fomin AV, Gidranovich AV. Otsenka tiazhesti sostoianiia bol'nykh ostrym pankreatitom (obzor literatury) [Assessment of the severity of the patients with acute pancreatitis (review)]. Vestn VGMU. 2004;3(1):4150.
  2. Koo BC, Chinogureyi A, Shaw AS. Imaging acute pancreatitis. Br J Radiol. 2010 Feb;83(986):10412.
  3. Dunaevskaia SS, Antiufrieva DA. Prognozirovanie vozmozhnogo iskhoda pri tiazhelom ostrom pankreatite [Predicting of the possible outcome in severe acute pancreatitis]. Vrach-aspirant. 2013;(1.1):20307.
  4. Mortele KJ, Ip IK, Wu BU, Conwell DL, Banks PA, Khorasani R.Acute pancreatitis: imaging utilization practices in an urban teaching hospital-analysis of trends with assessment of independent predictors in correlation with patient outcomes. Radiology. 2011 Jan;258(1):17481.
  5. Sinenchenko GI, Pivovarova LP, Shiliaev AV, Dvoinov VG. Prognosticheskie kriterii tiazhesti ostrogo destruktivnogo pankreatita [Diagnosis of acute pancreatitis in the early stages of the onset of the disease on the results of complex ultrasound examination]. Vestn Ros Voen-Med Akad. 2007;1(17):100105.
  6. Molchanova OV, Sadakh MV, Kaporskii VI, Aiushinova NI, Pak VE. Diagnostika ostrogo pankreatita v rannie sroki ot nachala zabolevaniia po rezul'tatam kompleksnogo ul'trazvukovogo issledovaniia [Diagnosis of acute pancreatitis in the early stages of the onset of the disease on the results of a comprehensive ultrasound]. Sib Med Zhurn. 2012;115(8):2631.
  7. Bierig SM, Jones A. Accuracy and cost comparison of ultrasound versus alternative imaging modalities, including CT, MR, PET, and angiography. JDMS. 2009 May;25(3):13844.
  8. Belokonev VIu, Iudin AE. Monitoring ostrogo pankreatita i pankreonekroza metodom spiral'noi komp'iuternoi tomografii [Monitoring of acute pancreatitis and pancreatic necrosis with spiral computed tomography]. Vestn SamGU. 2007;(2):15764.
  9. Kim HC, Yang DM, Kim HJ, Lee DH, Ko YT, Lim JW. Computed tomography appearances of various complications associated with pancreatic pseudocysts. Acta Radiol. 2008 Sep;49(7):72734.
  10. Spanier BW, Bruno MJ. Use of early CT scanning in patients with acute pancreatitis. Radiology. 2011 Aug;260(2):606.
  11. Shevchenko IuL, Vetshev PS, Kitaev VM, Kuzin VV, Levchuk AL. Sravnitel'naia otsenka magnitno-rezonansnoi tomografii i spiral'noi komp'iuternoi tomografii v diagnostike ostrogo pankreatita [Comparative evaluation of magnetic resonance imaging and spiral computed tomography in the diagnosis of acute pancreatitis]. Vestn Nats Med-Khirurg Tsentr im NI Pirogova. 2008;3(1):3-8.
  12. Armstrong EM, Tolan DJ, Verbeke CS, Sheridan MB. Evolution of idiopathic fibrosing pancreatitis-MRI features. Br J Radiol. 2008 Sep;81(969):e22527.
  13. Marolf AJ, Kraft SL, Dunphy TR, Twedt DC. Magnetic resonance (MR) imaging and MR cholangiopancreatography findings in cats with cholangitis and pancreatitis. J Feline Med Surg. 2013 Apr;15(4):28594.
  14. Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007 Mar;242(3):791801.
  15. Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. 1985 Sep;156(3):76772.
Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO Krasnoiarskii gosudarstvennyi meditsinskii universitet im. prof. V.F. Voino-Iasenetskogo, kafedra obshchei khirurgii,
e-mail: Vikto-potapenk@yandex.ru,
Dunaevskaya Svetlana Sergeevna
Information about the authors:
Vinnick Y.U. MD, a head of the chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky".
Dunaevskaya S.S. PhD, an associate professor of the chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky."
Antyufrieva D.A. A clinical resident of a chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky."
Contacts | ©Vitebsk State Medical University, 2007