Background

Assessment of the biliary origin of acute pancreatitis (AP) is crucial because it affects patient treatment to avoid recurrence. Although CT is systematically performed to determine severity in AP, its usefulness in assessing AP biliary origin has not been evaluated.

Purpose

To assess abdominal CT features associated with acute biliary pancreatitis (ABP) and to evaluate the predictive value of a combination of CT and clinical data for determining a biliary origin in a first episode of AP.

Materials and Methods

From December 2014 to May 2019, all consecutive patients who presented with a first episode of AP and with at least 6 months of follow-up were retrospectively reviewed. Evidence of gallstones was mandatory for a clinical diagnosis of ABP. Abdominal CT images were reviewed by two abdominal radiologists. Univariable and multivariable statistical analyses were performed, and a nomogram was constructed on the basis of the combination of clinical and CT features. This nomogram was validated in a further independent internal cohort of patients.

Results

A total of 271 patients (mean age ± standard deviation, 56 years ± 20; 160 men) were evaluated. Of these, 170 (63%) had ABP. At multivariable analysis, age (odds ratio [OR], 1.06; 95% CI: 1.03, 1.09; P < .001), alanine aminotransferase level (OR, 1.00; 95% CI: 1.00, 1.01; P = .009), gallbladder gallstone (OR, 15.59; 95% CI: 4.61, 68.62; P < .001), choledochal ring sign (OR, 5.73; 95% CI: 2.11, 17.05; P < .001), liver spontaneous attenuation (OR, 1.07; 95% CI: 1.04, 1.11; P < .001), and duodenal thickening (OR, 0.17; 95% CI: 0.03, 0.61; P = .01) were independently associated with ABP. The matching nomogram combining both clinical and CT features displayed an area under the curve of 0.94 (95% CI: 0.91, 0.97) in the study sample (n = 271) and 0.91 (95% CI: 0.84, 0.99) in the validation cohort (n = 51).

Conclusion

Abdominal CT provided useful features for diagnosis of acute biliary pancreatitis (ABP). Combining CT and clinical features in a nomogram showed good diagnostic performance for early diagnosis of ABP.

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Chang in this issue.

中文翻译：

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利用临床和腹部 CT 特征早期预测急性胆源性胰腺炎

背景

评估急性胰腺炎 (AP) 的胆汁来源至关重要，因为它会影响患者的治疗以避免复发。尽管系统地进行 CT 以确定 AP 的严重程度，但尚未评估其在评估 AP 胆源性方面的有用性。

目的

评估与急性胆汁性胰腺炎 (ABP) 相关的腹部 CT 特征，并评估 CT 和临床数据组合在确定 AP 首发中胆源性方面的预测价值。

材料和方法

从 2014 年 12 月至 2019 年 5 月，对所有首发 AP 并随访至少 6 个月的连续患者进行回顾性分析。胆结石的证据对于 ABP 的临床诊断是强制性的。腹部 CT 图像由两名腹部放射科医师审查。进行单变量和多变量统计分析，并在结合临床和CT特征的基础上构建列线图。该列线图在进一步独立的内部患者队列中得到验证。

结果

共评估了 271 名患者（平均年龄 ± 标准差，56 岁 ± 20；160 名男性）。其中，170 人（63%）患有 ABP。在多变量分析中，年龄（优势比 [OR]，1.06；95% CI：1.03，1.09；P < .001），丙氨酸氨基转移酶水平（OR，1.00；95% CI：1.00，1.01；P = .009），胆囊胆结石（OR，15.59；95% CI：4.61，68.62；P < .001），胆总管环征（OR，5.73；95% CI：2.11，17.05；P < .001），肝脏自发性衰减（OR，1.07 ; 95% CI: 1.04, 1.11; P < .001) 和十二指肠增厚 (OR, 0.17; 95% CI: 0.03, 0.61; P= .01) 与 ABP 独立相关。结合临床和 CT 特征的匹配列线图在研究样本 ( n = 271) 和验证队列中显示曲线下面积为 0.94 (95% CI: 0.91, 0.97 ) 和 0.91 (95% CI: 0.84, 0.99) ( n = 51)。

结论

腹部 CT 为诊断急性胆源性胰腺炎 (ABP) 提供了有用的特征。在列线图中结合 CT 和临床特征显示了 ABP 早期诊断的良好诊断性能。

© 北美放射学会，2021

本文提供在线补充材料。

另请参阅本期 Chang 的社论。