Diffusion weighted MRI and neutrophil lymphocyte ratio non-invasively predict infection in pancreatic necrosis: a pilot study

IF 1.6 4区医学 Q3 SURGERY ANZ Journal of Surgery Pub Date : 2024-11-05 DOI:10.1111/ans.19301

Rommel Sandhyav MS, MCh, Nihar Mohapatra MS, MCh, Nikhil Agrawal MS, MCh, Yashwant Patidar MD, Asit Arora MS, MCh, Tushar Kanti Chattopadhyay MS

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Abstract

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.

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弥散加权磁共振成像和中性粒细胞淋巴细胞比值无创预测胰腺坏死中的感染：一项试点研究。

背景：感染性胰腺坏死（IPN）是急性胰腺炎（AP）死亡率的主要决定因素。IPN 的无创诊断可为急性胰腺炎的干预提供指导。我们旨在研究弥散加权磁共振成像（DW-MRI）等无创方法和临床-实验室参数作为 IPN 预测因素的作用：方法：通过 DW-MRI 上的弥散限制（DR）和临床实验室参数对 IPN 的预测因素进行前瞻性评估：结果：在纳入的 39 名患者中，有 31 人被排除在外。其中 26 例（83.8%）患者为中度重度 AP，其余患者为重度疾病。他们被分为 A 组：介入治疗后有感染记录的患者（17 人）和 B 组：未经介入治疗成功控制或介入治疗后培养阴性的患者（14 人）。单变量分析显示，A 组患者发热（P = 0.020）、持续不适（P = 0.003）、中性粒细胞计数升高（P = 0.007）、淋巴细胞计数升高（P = 0.007）、中性粒细胞淋巴细胞比值（NLR）升高（P = 0.028）、DW-MRI 显示 DR（P = 0.001）和表观弥散系数（ADC）降低（P = 0.086）的发生率明显更高。多变量分析显示，除其他因素外，DW-MRI 上的 DR（P = 0.004）和 NLR（P = 0.035）也是 IPN 的重要预测因素。DW-MRI 的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 94.1%、78.6%、91.66% 和 84.21%。在 ROC 图上，NLR 的曲线下面积为 0.85，最佳临界值为 >3.5，敏感性、特异性、PPV 和 NPV 分别为 70.6%、78.6%、80% 和 68.7%：DW-MRI和NLR是准确预测IPN的无创工具，因此可以指导急性胰腺炎患者是否需要干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.