Clinical Characterizations Of Focal Pancreatitis Based On Imaging Diagnosis

Background and ObjectivesFocal pancreatitis is a special type of pancreatitis,which diagnosis is based on image showing a focal mass formation in the pancreas.However,the clinical diagnosis corresponding to focal pancreatitis by imaging diagnosis,may comply with focal pancreatitis,or may not comply with focal pancreatitis,mostly as pancreas and adjacent organs malignant tumors.Clinical understanding of focal pancreatitis by imaging diagnosis is insufficient,often unable for early formation of the correct clinical diagnosis.Timely and accurate diagnosis is particularly important for acute pancreatitis,for acute pancreatitis with or without focal inflammatory enlargement,little is known on differences between them.Object and methodIn the first part of this study,we respectively analyzed the medical records of 62 patients diagnosed with focal pancreatitis by imaging from January 1,2014 through December 31,2021 in Qilu Hospital of Shandong University.Firstly,the clinical diagnosis of 62 patients were described,and then they were divided into benign and malignant groups according to the clinical diagnosis results,and the clinical characteristics and imaging signs were collected.In the second part,we reviewed the medical records of a total of 24 patients diagnosed with focal acute pancreatitis by imaging and clinical diagnosis at Qilu Hospital of Shandong University.In Qilu Hospital of Shandong University 27 cases of acute pancreatitis which manifest non-localized pancreas inflammation were selected from the medical record system as the control group.Describe and analyze the clinical features of the two groups of patients.Retrospective observation research methods were adopted in this study.Results1.In this part of the study,a total of 62 patients with an imaging diagnosis of focal pancreatitis were included.A total of 36 cases’ final diagnosis matched with focal pancreatitis:including 24 cases as acute focal pancreatitis,10 cases as chronic focal pancreatitis,2 cases as autoimmune pancreatitis.A total of 26 cases’ final diagnosis cannot match with focal pancreatitis:including 14 cases as pancreatic ductal adenocarcinoma,1 case as pancreatic mucinous cystic tumor,1 case as pancreatic neuroendocrine tumor,2 cases as metastatic cancer,3 cases as duodenal cancer,1 case as cholangiocarcinoma,1 case as duodenal cyst,1 case as annular pancreas,2 cases failure to confirm the diagnosis.2.In the benign and malignant groups,there were statistically significant differences in the mean age(44.56± 17.62 VS 60.41 ± 10.05,P<0.001),abdominal pain(88.9%VS 63.6%,P=0.042),nausea and vomiting symptoms(47.2%VS 18.2%,P=0.047),serum direct bilirubin(4.4(2.3,5.6)VS 8.8(4.8,86.9),P=0.023),serum CA-199(17.78(12.59,23.80)VS 164.69(40.31,279.11),P<0.001),peripaniatic vascular involvement(6.5%VS 46.2%,P=0.005),peripatic lymphadenopathy(38.7%VS 76.9%,P=0.021),common bile duct truncation(8.3%VS 40.0%,P=0.048),and biduct signs(8.3%VS 50.0%,P=0.014).3.Differences between the two groups in bloating(4.2%VS 29.6%,P=0.026),signs of abdominal tenderness(58.3%VS 85.2%,P=0.032),peripheral blood neutrophil ratio(60.1 ± 23.3VS75.9 ± 12.6,P=0.004),serum D-Dimer(0.40(0.25,0.98)VS 1.59(0.49,4.63),P=0.008),serum GGT(40(25,91)VS 120(22,383),P=0.046),serum amylase(435(241,718)VS 591(394,1333),P=0.044)and serum lipase(988(648,1067)VS 1686(525,2675),P=0.027)were statistically significant(P<0.05).Conclution1.The clinical diagnosis of focal pancreatitis diagnosed by imaging,in addition to acute focal pancreatitis,chronic focal pancreatitis,there are also 41.9%clinical diagnoses not consistent with focal pancreatitis,including malignant or benign masses of pancreas and surrounding organs,of which malignant masses is more common,accounting for 84.6%.Therefore,clinical work should be vigilant when there are focal pancreatitis by imaging diagnosis,when clinical etiology diagnosis can not be confirmed as focal pancreatitis,highly doubt the possibility of tumor is needed.2.The mean age,abdominal ache,nausea and vomiting,levels of serum direct bilirubin,and CA-199,and peripancreatic vascular involvement,peripancreatic lymph node enlargement,common bile duct truncation,dual duct signs,can help to identify the malignant clinical diagnosis of patients with focal pancreatitis.3.Compared with non-localized acute pancreatitis,patients with focal acute pancreatitis have smaller proportions of bloating,abdominal tenderness,and lower levels of peripheral blood neutrophil ratio,serum D-dimer,GGT,amylase and lipase.Nonsignificance of changes in symptoms,signs and laboratory indicators,indicating that we should pay great attention in clinical practice.