Acute pancreatitis after pancreatoduodenectomy: A prospective study of diffusion-weighted magnetic resonance imaging, serum biomarkers, and clinical features.

BACKGROUND: Postpancreatectomy acute pancreatitis is challenging to diagnose and poorly characterized in its early phases. However, it represents the ideal target for novel therapeutic opportunities possibly gleaned from medical acute pancreatitis. This study aims to systematically investigate early radiologic, biochemical, and clinical features of postpancreatectomy acute pancreatitis. METHODS: This was a prospective observational study of patients undergoing pancreatoduodenectomy from September 2019 to January 2021. Diffusion-weighted magnetic resonance imaging was performed on postoperative day 3. Serum pancreatic amylase and lipase were assessed daily until postoperative day 5. Postoperative serum hyperamylasemia and postpancreatectomy acute pancreatitis were defined based on the International Study Group for Pancreatic Surgery definition. RESULTS: A total of 65 patients were enrolled according to the sample size calculation. Patients with postoperative serum hyperamylasemia and postpancreatectomy acute pancreatitis had significantly lower apparent diffusion coefficient values at diffusion-weighted magnetic resonance imaging but no macroscopic features consistent with acute pancreatitis. Subsequently, 21 patients (32.3%) underwent computed tomography imaging for clinical worsening, and 6 had radiologic features of acute pancreatitis. All these latter patients had postoperative serum hyperamylasemia and worse outcomes, characterized by local (postoperative pancreatic fistula: 83%) and systemic morbidity (sepsis: 66.7%). The postoperative serum hyperamylasemia incidence was 21.5% (n = 14), and postpancreatectomy acute pancreatitis occurred in 6 patients (9.2%), with 4 grade B (6.1%) and 2 grade C (3%). CONCLUSION: Postpancreatectomy acute pancreatitis is characterized by early serum hyperamylasemia and hyperlipasemia. Although pancreatic changes may appear at postoperative day 3 diffusion-weighted magnetic resonance imaging, its standard use has no impact on postoperative management. Macroscopic radiologic features appear later and correlate with worse clinical scenarios. This paper paves the ground for including postpancreatectomy acute pancreatitis in the spectrum of acute pancreatitis, promoting the transfer of treatment strategies for acute pancreatitis into managing postpancreatectomy acute pancreatitis.

Rapid onset of bronchiectasis in COVID-19 Pneumonia: two cases studied with CT.

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19 unenhanced computed tomography (CT) was considered an useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated COVID-19 pneumonia. Many typical imaging features of this disease were described such as bilateral multilobar ground-glass opacification (GGO) with a prevalent peripheral or posterior distribution, mainly in the lower lobes, and sometimes consolidative opacities superimposed on GGO. As less common findings were mentioned septal thickening, bronchiectasis, pleural thickening, and subpleural involvement. After 3 months from the onset of COVID-19 pneumonia some studies published the evolution of imaging features of COVID-19 pneumonia such as an increase of GGOs and a progressive transformation of GGO into multifocal consolidative opacities, septal thickening, and development of a crazy-paving pattern. As far as we know bronchiectasis were described only as a possible aspecific imaging feature of COVID-19 pneumonia and no studies reporting the onset or evolution of bronchiectasis during imaging follow-up in patients with COVID-19 have been published. Here we describe two cases of rapid evolution of bronchiectasis documented at CT in patients with COVID-19 pneumonia. Further studies are necessary to determine predisposing factors to the onset of bronchiectasis and to evaluate clinical correlation with respiratory distress. Radiologists should always consider bronchial features when they report CT scans of patients with COVID-19 pneumonia.

Preoperative workflow for lymph nodes staging.

PURPOSE: Accurate staging of lymph nodes relies mainly on surgical exploration and manual palpation. We present a new non-invasive diagnostic approach: simulated palpation through virtual laparoscopic instruments. METHODS: We set up a diagnostic process to extract lymph nodes shape and position from CTs and to analyze the trend of pixels intensities to determine tissue properties in order to feedback the force information. RESULTS: We have integrated the model, obtained from both the morphological information and stiffness values, in our laparoscopy simulator and surgeons can virtually palpate, with a haptic device, the lymph nodes. We evaluated the workflow extracting lymph nodes from a case study: the feedback provided through the simulator greatly helps the surgeon in the correct staging. CONCLUSIONS: Results show the feasibility of the approach and in the future we will clinically evaluate this new diagnostic methodology. We are studying the possibility to integrate CTs with other imaging systems to increase the accuracy.