RESUMO
BACKGROUND: Many scores have been suggested to assess the severity of acute pancreatitis upon onset. The extrapancreatic necrosis volume is a novel, promising score that appears to be superior to other scores investigated so far. AIM: To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis. METHODS: A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology, St Spiridon Hospital between January 1, 2017 and December 31, 2019 were analyzed retrospectively. Pancreatitis was classified according to the revised Atlanta classification (rAC) as mild, moderate, or severe. Severity was also evaluated by computed tomography and classified according to the computed tomography severity index (CTSI) and the modified CTSI (mCTSI). The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method. RESULTS: The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC (r = 0.926, P < 0.001 and r = 0.950, P < 0.001; r = 0.784, P < 0.001, respectively). The correlation of C-reactive protein with severity was positive but not as strong, and was not significant (r = 0.133, P = 0.154). The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume [area under the curve (AUC) = 0.993; 95% confidence interval (CI): 0.981-1.005], with a 99.5% sensitivity and 99.0% specificity at a cutoff value of 167 mL, followed by the mCTSI 2007 score (AUC = 0.972; 95%CI: 0.946-0.999), with a 98.0% sensitivity and 96.5% specificity, and the CTSI 1990 score (AUC = 0.969; 95%CI: 0.941-0.998), with a 97.0% sensitivity and 95.0% specificity. CONCLUSION: Radiological severity scores correlate strongly and positively with disease activity. Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.
RESUMO
Aims: The purpose of this study was to assess the changes in hepatic morphology evaluated by computed tomography (CT) examination in patients with hepatitis C virus (HCV)-related compensated cirrhosis who achieved sustained virologic response (SVR) after direct-acting antivirals (DAAs) treatment. Methods: CT examination was performed in 56 patients with HCV-related compensated cirrhosis before and within 6-18 months after the treatment with Ombitasvir/Paritaprevir/ritonavir + Dasabuvir. The liver CT changes were assessed by measuring liver volume, caudate-right lobe ratio (C/RL), hepatic vessels diameters, periportal widening space, and right posterior notch. Portal trunk, splenic and superior mesenteric vein diameters, as well as spleen volume were assessed as part of portal hypertension. Results: Right hepatic vein diameter was significantly wider after treatment (median: 8.12 mm; IQR: 4.20) than before treatment (median: 6.36 mm; IQR: 3.94) z = -3.894; p < 0.001. The liver volume was significantly higher prior to the treatment (median: 1786.77 mm3; IQR: 879.23) than after treatment (median: 1716.44 mm3; IQR: 840.50), z = -1.970; p = 0.049. Splenic volume was considerably higher before treatment (median: 564.79 mm3; IQR: 342.54) than after (median: 474.45 mm3; IQR: 330.00), z = -2.500; p = 0.012. The other parameters, such as C/RL, periportal space widening, and right hepatic notch showed no significant changes. Conclusions: SVR in patients with HCV-related compensated cirrhosis treated with DAAs is associated with some improvements of hepatic morphology detectable by CT, the most constant being the increase of right hepatic vein diameter.