MR Imaging Of Acute Pancreatitis: Correlation Of Abdominal Wall Edema With Severity Scores

PARTⅠMR imaging of Abdominal wall edema in Acute PancreatitisObjective: To study MRI findings of abdominal wall edema (AWE) inacute pancreatitis as well as correlations between AWE and the severity ofacute pancreatitis according to the MR severity index (MRSI) and the AcutePhysiology And Chronic Healthy EvaluationⅢ(APACHEⅢ) scoringsystem.Materials and Methods: A total of 160 patients with AP admitted toour institution between December 2009 and March 2011 were included inthis study. MRI was performed within 48 h after admission. MRI findings ofacute pancreatitis were noted, including AWE on the MRI. The abdominalwall area was divided into quarters, and each area involved was recorded as1 point to score the severity of AWE. The severity of acute pancreatitis wasstudied using both the MRSI and the APACHE III scoring system. Spearmancorrelation of AWE with the MRSI and the APACHE III scoring system wasanalyzed.Results: In 160 patients with acute pancreatitis, 53.8% had AWE onMRI. The average AWE score was 1.2±1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively,according to MRSI. AWE on MRI was correlated with MRSI scores (r=0.441,p=0.000). According to APACHE III scores, the averages were 2.0±1.1 and2.6±1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE wasslightly correlated with the APACHEⅢscores (r=0.222, p=0.005).Conclusion: AWE on MRI in acute pancreatitis is common, which maybe a supplementary indicator in determining the severity of AP. PARTⅡMRI imaging of Abdominal wall edema in Acute Pancreatitisand Non-pancreatitisObjective: To study MRI findings of abdominal wall edema (AWE) inacute pancreatitis group and Non-pancreatitis group. And analyze thedifference of two groups with abdominal wall edema imaging.Materials and Methods: In group one, a total of 160 patients with APadmitted to our institution between December 2009 and March 2011 wereincluded in this study. In group two, 783 patients without AP admitted toour study in the same period. MRI was performed within 48 h after recorded respectively. The abdominal wall area was divided into quarters.The prevalence of AWE of each area was recorded. And analyze thedifference of the prevalence between the two groups and different areaswith abdominal wall edema.Results: In 160 patients with acute pancreatitis, 53.8% (86/160) hadAWE on MRI. The prevalence of the left posterior abdominal wall edema wasthe highest, reaching 87.2%. In group two with 783 Non-pancreatitis, 8.2%(64/783) had AWE on MRI. The prevalence of the right anterior abdominalwall edema was the highest, reaching 70.3%. The prevalence of the twogroups existed statistically significant difference（P=0.000）. In group one, 86AP with AWE, 18.6%（16/86）involved the fat layer. And there were 21.9%（14/64）patients involved the fat layer. However the statistically differencewas not existing between the two groups（P=0.620）.Conclusion: The prevalence of AWE on MRI in acute pancreatitis ishigh. And AWE may be a supplementary simple indicator in determining theseverity of AP. PARTⅢMagnetic resonance imaging versus Acute Physiology AndChronic Healthy EvaluationⅢscore in predicting the severity of acutepancreatitisObjective: To study the severity of acute pancreatitis（AP）by usingmagnetic resonance imaging (MRI) and the Acute Physiology And ChronicHealthy EvaluationⅢ(APACHEⅢ) score, and the correlation betweencorresponding MRI findings and APACHEⅢscores.Methods: One hundred patients with AP undergoing abdominal MRIwere recruited in the study. The MRI features of acute pancreatitis wererecorded. The severity of acute pancreatitis on MRI was graded by MRseverity index (MRSI) as mild (0–2 points)，moderate (3–6 points) andsevere (7–10 points）acute pancreatitis. APACHEⅢscore was denoted forAP was as mild (＜30 points) and severe (≥30 points) . The local andsystematic complications, mortality, need to intense care unit (ICU), andhospitalization time were recorded and compared with MRSI and APACHEⅢscore. Non-parametric spearman correlation was calculated for testing thecorrelation between the MRSI, the APACHEⅢand hospitalization time.The correlation of clinical results with MRSI, and with APACHEⅢwascalculated byχ2test.Results: In the 100 patients with AP, there were respectively 80 and 20 patients with edematous and necrotic pancreatitis on MR imaging. Accordingto MRSI, 34, 59 and 7 patients had mild, moderate and severe acutepancreatitis according, respectively. The APACHEⅢscore was 24.87±12.23points (range: 2-72 points). 68 patients had less than 30 points and 32patients had more than 30 point of APACHEⅢscore. There were significantdifferences in the local complication, systematic complication, need to ICUamong the three groups in MRSI score, respectively（χ2=9.161,P=0.010;χ2=19.118,P=0.000;χ2=54.767,P=0.000）. There was difference in thesystematic complication between mild and severe AP in APACHEⅢscore（χ2=7.730，P=0.005）, but there were no differences（χ2=2.079，χ2=2.522;P>0.05）in the local complication, need to ICU between mild and severe APin APACHEⅢscore. There was weak correlation（r=0.235，P=0.019）between MRSI score and hospitalization time, and no difference（r=0.168, P＞0.05; r=0.105, P＞0.05）between APACHEⅢand MRSI, APACHEⅢand hospitalization time, respectively.Conclusion：Both MRSI and APACHEⅢscore may predictsystematiccomplications. However, MRSI is superior to APACHEⅢin predicting thelocal complications, need to ICU and hospitalization time in patients withacute pancreatitis.