review of literature on clinical pancreatology - The Pancreapedia

evaluated the presence or absence <strong>of</strong> acute pancreatitis, complications and the cause <strong>of</strong>acute pancreatitis on the MRI and CT images. There were no differences between the DWIand the CT images regarding their abilities to detect acute pancreatitis. However, DWI coulddetect acute pancreatitis more clearly than CT without enhancing material. The DWI findingswere consistent with the clinical findings, the results <strong>of</strong> chemical analyses and the CTfindings. Furthermore, DWI could detect pancreatic cancer causing acute pancreatitis andMR cholangiopancreatography (MRCP) could detect choledocholithiasis and pancreasdivisum causing acute pancreatitis [186].To determine the diagnostic value <strong>of</strong> magnetic resonance (MR) grading focusing on elevatedsignal on T1-weighted images in the prediction <strong>of</strong> severity and prognosis <strong>of</strong> acutepancreatitis as compared with the Balthazar computed tomography (CT) grading 31 patientswith acute pancreatitis who underwent CT and MR imaging including fat-suppressed T1-weighted images within a 48-hour interval were included in a study. The severity <strong>of</strong>pancreatitis was evaluated by two observers using the Balthazar CT grading system and anMR grading system that is focused on an elevated signal on T1-weighted images. The MRgrading was correlated with the CT grading, and each MR or CT grade was compared withpatient outcome parameters, including the duration <strong>of</strong> hospitalization, local and systemiccomplications, and clinical outcome grading. There was a significant correlation between CTand MR gradings for pancreatic or peripancreatic inflammation. However, for all <strong>of</strong> theoutcome parameters and outcome grading, a stronger correlation was seen with the MRgrading than with the CT grading. No significant correlation was found between CT gradingand infected necrosis. It was concluded that magnetic resonance imaging including fatsuppressedT1-weighted images is more accurate to predict the severity and prognosis <strong>of</strong>acute pancreatitis in comparison with CT [187].Economical aspectsBoth endoscopic retrograde cholangiopancreatography (ERCP) and endoscopicultrasonography (EUS) are commonly performed in the evaluation <strong>of</strong> idiopathic pancreatitis.However, comparative trials <strong>of</strong> these modalities are lacking, and thus the ideal endoscopicdiagnostic strategy to evaluate idiopathic pancreatitis remains unknown. A decision analysismodel <strong>of</strong> patients with 2 attacks <strong>of</strong> idiopathic pancreatitis with gallbladder in situ wasconstructed using TreeAge s<strong>of</strong>tware. It was analyzed cost and overall diagnostic ability <strong>of</strong> 3strategies, namely, EUS, ERCP with manometry and bile aspiration, and laparoscopiccholecystectomy. Using the base case analysis, initial EUS was the preferred initial modalityfor the diagnosis. The expected cost for initial EUS was USD 4469 compared with USD 4615for ERCP and USD 6268 for laparoscopic cholecystectomy. For cholecystectomy to be thepreferred strategy, the total cost would need to be less than USD 1314, well below anyrealistic cost estimate. If the prevalence <strong>of</strong> microlithiasis/sludge was greater than 80 percent,then cholecystectomy would be preferred, whereas ERCP would be preferred with aprevalence <strong>of</strong> less than 41 percent. This cost minimization study identifies EUS as the leastcostly initial test for the diagnostic evaluation <strong>of</strong> patients with idiopathic pancreatitis withgallbladder in situ [188].Differential diagnosisEctopic pregnancy may lead to massive haemorrhage, infertility or death. Prompt diagnosisand treatment are crucial to save patients who would otherwise die. Serum amylase andlipase measurements are known biochemical markers <strong>of</strong> pancreatic inflammation and arecognized finding that may help diagnose acute pancreatitis. It was now reported that amisdiagnosed ruptured ectopic pregnancy in the event <strong>of</strong> elevated activities <strong>of</strong> pancreaticenzymes may lead to delayed diagnosis <strong>of</strong> haemorrhage to peritoneum, resulting in