Akut Pankreatitte Radyolojik Bulgular
Özet
Akut pankreatit (AP), en sık gastrointestinal sistem kaynaklı hastane yatışlarına yol açan, hafif ödemden hayatı tehdit eden nekroza kadar değişebilen inflamatuar bir hastalıktır. Klinik tanısında karın ağrısı, serum amilaz/lipaz değerlerinin üç kat artışı ve radyolojik bulgular temel alınır. Hastalık morfolojik olarak interstisyel ödematöz pankreatit ve akut nekrotizan pankreatit olmak üzere ikiye ayrılır. Gözden geçirilmiş Atlanta sınıflaması, peripankreatik sıvı koleksiyonu, psödokist, akut nekrotizan koleksiyon ve duvarlı pankreatik nekroz (DPN) gibi sıvı oluşumlarını netleştirerek klinikler arası standardizasyon sağlar. Radyolojik görüntülemede Ultrasonografi (US), Bilgisayarlı Tomografi (BT) ve Manyetik Rezonans Görüntüleme (MRG) etkin olarak kullanılır. US safra taşlarında duyarlıyken, kontrastlı BT yüksek doğruluk oranı ve nekroz tespiti nedeniyle ana yöntemdir. MRG ise kontrast alerjisi, gebelik durumlarında ve vasküler komplikasyonlar ile koleksiyon içeriklerinin detaylandırılmasında tercih edilir. İlk hafta erken evre olup görüntülemenin katkısı sınırlıyken, 2. haftadan itibaren geç evrede lokal komplikasyonlar ve organ yetmezlikleri değerlendirilir. Balthazar BT ve Modifiye BT şiddet indeksleri, hastaların prognozunu ve hastalık derecesini belirlemede kritik öneme sahiptir. Sonuç olarak radyoloji; tanı, enfeksiyon gibi komplikasyonların saptanması ve perkütan drenaj veya cerrahi gibi tedavi süreçlerinin planlanmasında multidisipliner yönetimin en temel kılavuzudur.
Acute pancreatitis (AP) is an inflammatory disease that causing the most frequent gastrointestinal hospitalizations, ranging from mild edema to life-threatening necrosis, which diagnosed by abdominal pain, threefold increase in amylase/lipase, and radiological findings. Morphologically classified into interstitial edematous and acute necrotizing pancreatitis, the revised Atlanta classification standardizes definitions of fluid collections including acute peripancreatic fluid, pseudocyst, acute necrotic collection, and walled-off pancreatic necrosis. Ultrasound (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are utilized, with contrast-enhanced CT being the primary modality for necrosis detection, whereas MRI is preferred for contrast allergies, pregnancy, and detailed fluid/vascular evaluations. Imaging is limited in the early phase during the first week, but crucial after the second week to assess local complications, organ failure, and treatment options like percutaneous drainage or surgery, utilizing the Balthazar and Modified CT severity indexes for prognosis, making radiology indispensable for managing this multidisciplinary condition.
Referanslar
Iannuzzi JP, King JA, Leong JH, Quan J, Windsor JW, Tanyingoh D, vd. Global Incidence of Acute Pancreatitis Is Increasing Over Time: A Systematic Review and Meta-Analysis. Gastroenterology. Ocak 2022;162(1):122-34.
Lankisch PG, Apte M, Banks PA. Acute pancreatitis. Lancet. 04 Temmuz 2015;386(9988):85-96.
Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. Radiographics. Haziran 2016;36(3):675-87.
Gapp J, Hall AG, Walters RW, Jahann D, Kassim T, Reddymasu S. Trends and Outcomes of Hospitalizations Related to Acute Pancreatitis: Epidemiology From 2001 to 2014 in the United States. Pancreas. Nisan 2019;48(4):548-54.
Petrov MS, Shanbhag S, Chakraborty M, Phillips ARJ, Windsor JA. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology. Eylül 2010;139(3):813-20.
Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 17 Kasım 2016;375(20):1972-81.
Lee JK, Enns R. Review of idiopathic pancreatitis. World J Gastroenterol. 21 Aralık 2007;13(47):6296-313.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, vd. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. Ocak 2013;62(1):102-11.
Spanier BWM, Nio Y, van der Hulst RWM, Tuynman H a. RE, Dijkgraaf MGW, Bruno MJ. Practice and yield of early CT scan in acute pancreatitis: a Dutch Observational Multicenter Study. Pancreatology. 2010;10(2-3):222-8.
Shyu JY, Sainani NI, Sahni VA, Chick JF, Chauhan NR, Conwell DL, vd. Necrotizing pancreatitis: diagnosis, imaging, and intervention. Radiographics. Ekim 2014;34(5):1218-39.
Rickes S, Treiber G, Mönkemüller K, Peitz U, Csepregi A, Kahl S, vd. Impact of the operator’s experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: a prospective comparison using endoscopic retrograde cholangiography as the gold standard. Scand J Gastroenterol. Temmuz 2006;41(7):838-43.
Uğur Toprak. Pankreas Radyolojisi. Içinde: Temel Radyoloji. Ankara: Güneş Tıp Kitapevleri; 2015. s. 983.
Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. Haziran 2002;223(3):603-13.
Miller FH, Keppke AL, Dalal K, Ly JN, Kamler VA, Sica GT. MRI of pancreatitis and its complications: part 1, acute pancreatitis. AJR Am J Roentgenol. Aralık 2004;183(6):1637-44.
Gillams AR, Kurzawinski T, Lees WR. Diagnosis of duct disruption and assessment of pancreatic leak with dynamic secretin-stimulated MR cholangiopancreatography. AJR Am J Roentgenol. Şubat 2006;186(2):499-506.
Baker ME, Nelson RC, Rosen MP, Blake MA, Cash BD, Hindman NM, vd. ACR Appropriateness Criteria® acute pancreatitis. Ultrasound Q. Aralık 2014;30(4):267-73.
Thoeni RF. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment. Radiology. Mart 2012;262(3):751-64.
Singh VK, Bollen TL, Wu BU, Repas K, Maurer R, Yu S, vd. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. Aralık 2011;9(12):1098-103.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. Ekim 1995;23(10):1638-52.
Lenhart DK, Balthazar EJ. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. AJR Am J Roentgenol. Mart 2008;190(3):643-9.
Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, vd. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. Kasım 2012;41(8):1176-94.
Triantopoulou C, Delis S, Dervenis C. Imaging evaluation of post-pancreatitis infection. Infect Disord Drug Targets. Şubat 2010;10(1):15-20.
Tüney D, Altun E, Barlas A, Yegen C. Pancreatico-colonic fistula after acute necrotizing pancreatitis. Diagnosis with spiral CT using rectal water soluble contrast media. JOP. 08 Ocak 2008;9(1):26-9.
Besselink M, van Santvoort H, Freeman M, Gardner T, Mayerle J, Vege SS, vd. IAP/APA evidence-based guidelines for the management of acute pancreatitis. PANCREATOLOGY. 2013;13(4, suppl 2):E1-15.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Official journal of the American College of Gastroenterology | ACG. Eylül 2013;108(9):1400-15.
Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). Aralık 2011;13(12):839-45.
Memiş A, Parildar M. Interventional radiological treatment in complications of pancreatitis. Eur J Radiol. Eylül 2002;43(3):219-28.
Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. Eylül 1985;156(3):767-72.
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. Şubat 1990;174(2):331-6.
Mortele KJ, Wiesner W, Intriere L, Shankar S, Zou KH, Kalantari BN, vd. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. Kasım 2004;183(5):1261-5.
Yirgin İK, Hocaoğlu E, Yirgin H, Kayhan A, Güner NT, Gömeç SK, vd. Akut pankreatitli hastalarda, hastalığın şiddetini belirlemede bilgisayarlı tomografi ve modifiye bilgisayarlı tomografi şiddet indekslerinin karşılaştırılması. Marmara Medical Journal. 30 Mart 2015;27(3):190-4.
