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• Clinical Article •
Nomogram model based on clinical manifestations and MRI features to early predict the prognosis of peripancreatic collections in acute pancreatitis
LUO Jiang  LIU Tingting  ZHANG Xueying  JIANG Donglin  ZHANG Xiaoming 

Cite this article as: LUO J, LIU T T, ZHANG X Y, et al. Nomogram model based on clinical manifestations and MRI features to early predict the prognosis of peripancreatic collections in acute pancreatitis[J]. Chin J Magn Reson Imaging, 2023, 14(11): 68-76. DOI:10.12015/issn.1674-8034.2023.11.012.


[Abstract] Objective To explore the prognostic factors of acute pancreatitis (AP) and build a nomogram model based on clinical manifestations and MRI features to predict the prognosis of peripancreatic collections (PPCs) in early stages of AP.Materials and methods We conducted a retrospective study involving 102 patients with peripancreatic collections of AP admitted to our hospital from January 2016 to February 2023. Patients were categorized into two groups based on clinical and imaging follow-up outcomes: good prognosis and poor prognosis. A multifactorial logistic regression analysis was performed to establish a nomogram based on clinical manifestations and MRI features for early prognosis prediction. The nomogram's performance was evaluated by calculating the area under the curve (AUC) of receiver operating characteristic (ROC), bootstrap resampling, and visual inspection of the calibration curve. Additionally, decision curve analysis (DCA) was used to assess the nomogram's clinical utility.Results Of the 102 AP patients with peripancreatic collections, 77 had a good prognosis, while 25 had a poor prognosis. Compared to the good prognosis group, indicators associated with poor prognosis, such as complications of AP, Extrapancreatic Inflammation on MRI (EPIM), Bedside Index for Severity in AP (BISAP), the number of peripancreatic spaces related to PPCs, MR Severity Index (MRSI), the maximum dimensional area of PPCs, classification of PPCs, the diffusion range grading of PPCs involving sub-peritoneal spaces, and involvement of the abdominal wall and peripancreatic vessels, showed a significant increase in proportion (P＜0.05). Multifactorial prognostic analysis revealed that MRSI, EPIM, maximal dimensional area of PPCs, and BISAP score were independent prognostic factors for early prognosis prediction of PPCs in AP. The nomogram demonstrated excellent performance, with an AUC of 0.946 (95% CI: 0.905-0.988) and excellent agreement between predicted and observed probabilities, as indicated by calibration curves. The DCA curve further confirmed its clinical utility.Conclusions A nomogram model based on clinical manifestations and MRI features can effectively predict the early prognosis of PPCs in AP.
[Keywords] acute pancreatitis；magnetic resonance imaging；peripancreatic collections；nomogram；predict；prognosis

LUO Jiang   LIU Tingting   ZHANG Xueying   JIANG Donglin   ZHANG Xiaoming*  

Sichuan Key Laboratory of Medical Imaging, Department of Radiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637001, China

Corresponding author: ZHANG X M, E-mail: cjr.zhxm@vip.163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS 2022 North Sichuan Medical College Affiliated Hospital Research and Development Programme (Unveiling and Hanging) Project (No. 2022JB001); Provincial Key Laboratory and Special Cultivation Fund of North Sichuan Medical College in 2022 (No. CBY22-PT01).
Received  2023-07-04
Accepted  2023-10-27
DOI: 10.12015/issn.1674-8034.2023.11.012
Cite this article as: LUO J, LIU T T, ZHANG X Y, et al. Nomogram model based on clinical manifestations and MRI features to early predict the prognosis of peripancreatic collections in acute pancreatitis[J]. Chin J Magn Reson Imaging, 2023, 14(11): 68-76. DOI:10.12015/issn.1674-8034.2023.11.012.

[1]
HECKLER M, HACKERT T, HU K, et al. Severe acute pancreatitis: surgical indications and treatment[J]. Langenbecks Arch Surg, 2021, 406(3): 521-535. DOI: 10.1007/s00423-020-01944-6.
[2]
SONG L J, XIAO B. Acute pancreatitis: structured report template of magnetic resonance imaging[J]. World J Radiol, 2023, 15(6): 157-169. DOI: 10.4329/wjr.v15.i6.157.
[3]
XIAO N J, CUI T T, LIU F, et al. Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis[J]. World J Gastrointest Surg, 2021, 13(7): 633-644. DOI: 10.4240/wjgs.v13.i7.633.
[4]
BARON T H, DIMAIO C J, WANG A Y, et al. American gastroenterological association clinical practice update: management of pancreatic necrosis[J]. Gastroenterology, 2020, 158(1): 67-75. DOI: 10.1053/j.gastro.2019.07.064.
[5]
ZEREM E, IMAMOVIĆ G, LATIĆ F, et al. Prognostic value of acute fluid collections diagnosed by ultrasound in the early assessment of severity of acute pancreatitis[J]. J Clin Ultrasound, 2013, 41(4): 203-209. DOI: 10.1002/jcu.21995.
[6]
SARR M G. 2012 revision of the Atlanta classification of acute pancreatitis[J]. Pol Arch Med Wewn, 2013, 123(3): 118-124. DOI: 10.20452/pamw.1627.
[7]
THOENI R F. The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment[J]. Radiology, 2012, 262(3): 751-764. DOI: 10.1148/radiol.11110947.
[8]
ELKHATIB I, SAVIDES T, FEHMI S M A. Pancreatic fluid collections: physiology, natural history, and indications for drainage[J]. Tech Gastrointest Endosc, 2012, 14(4): 186-194. DOI: 10.1016/j.tgie.2012.06.003.
[9]
HEATH D I, WILSON C, GUDGEON A M, et al. Trypsinogen activation peptides (TAP) concentrations in the peritoneal fluid of patients with acute pancreatitis and their relation to the presence of histologically confirmed pancreatic necrosis[J]. Gut, 1994, 35(9): 1311-1315. DOI: 10.1136/gut.35.9.1311.
[10]
MAYER A D, AIREY M, HODGSON J, et al. Enzyme transfer from pancreas to plasma during acute pancreatitis. The contribution of ascitic fluid and lymphatic drainage of the pancreas[J]. Gut, 1985, 26(9): 876-881. DOI: 10.1136/gut.26.9.876.
[11]
KOUTROUMPAKIS E, DASYAM A K, FURLAN A, et al. Isolated peripancreatic necrosis in acute pancreatitis is infrequent and leads to severe clinical course only when extensive: a prospective study from a US tertiary center[J]. J Clin Gastroenterol, 2016, 50(7): 589-595. DOI: 10.1097/MCG.0000000000000482.
[12]
ZHAO Y M, WEI J Y, XIAO B, et al. Early prediction of acute pancreatitis severity based on changes in pancreatic and peripancreatic computed tomography radiomics nomogram[J]. Quant Imaging Med Surg, 2023, 13(3): 1927-1936. DOI: 10.21037/qims-22-821.
[13]
GRASSEDONIO E, TOIA P, GRUTTA L L, et al. Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis[J]. Gland Surg, 2019, 8(2): 123-132. DOI: 10.21037/gs.2018.12.07.
[14]
MURPHY K P, O'CONNOR O J, MAHER M M. Updated imaging nomenclature for acute pancreatitis[J]. AJR Am J Roentgenol, 2014, 203(5): W464-W469. DOI: 10.2214/AJR.13.12222.
[15]
THOENI R F. Imaging of acute pancreatitis[J]. Radiol Clin N Am, 2015, 53(6): 1189-1208. DOI: 10.1016/j.rcl.2015.06.006.
[16]
ZHOU T, TANG M Y, DENG Y, et al. MR imaging for early extrapancreatic necrosis in acute pancreatitis[J]. Acad Radiol, 2021, 28(Suppl 1): S225-S233. DOI: 10.1016/j.acra.2019.10.023.
[17]
TANG W, ZHANG X M, XIAO B, et al. Magnetic resonance imaging versus Acute Physiology And Chronic Healthy Evaluation Ⅱ score in predicting the severity of acute pancreatitis[J]. Eur J Radiol, 2011, 80(3): 637-642. DOI: 10.1016/j.ejrad.2010.08.020.
[18]
ZEREM D, ZEREM O, ZEREM E. Role of clinical, biochemical, and imaging parameters in predicting the severity of acute pancreatitis[J]. Euroasian J Hepatogastroenterol, 2017, 7(1): 1-5. DOI: 10.5005/jp-journals-10018-1202.
[19]
GOMEZ-PAZ S, LAM E, GONZALEZ-MOSQUERA L, et al. MELD-Na score, Acute Physiologic and Chronic Health Evaluation Ⅱ score, and SOFA score and their association with mortality in critically ill COVID-19 patients with liver injury: a retrospective single-center study[J]. Int J Crit Illn Inj Sci, 2022, 12(4): 222-228. DOI: 10.4103/ijciis.ijciis_29_22.
[20]
WU B, YANG J, DAI Y H, et al. Combination of the BISAP score and miR-155 is applied in predicting the severity of acute pancreatitis[J]. Int J Gen Med, 2022, 15: 7467-7474. DOI: 10.2147/IJGM.S384068.
[21]
BALTHAZAR E J. Complications of acute pancreatitis: clinical and CT evaluation[J]. Radiol Clin North Am, 2002, 40(6): 1211-1227. DOI: 10.1016/s0033-8389(02)00043-x.
[22]
LENHART D K, BALTHAZAR E J. MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections[J]. AJR Am J Roentgenol, 2008, 190(3): 643-649. DOI: 10.2214/AJR.07.2761.
[23]
AYAZ E, ÖZCAN H N, HıZARCıOĞLU GÜLŞEN H, et al. Acute pancreatitis and acute recurrent pancreatitis in children: imaging findings and outcomes[J]. Turk Arch Pediatr, 2023, 58(1): 89-97. DOI: 10.5152/TurkArchPediatr.2022.22130.
[24]
JIANG Z Q, XIAO B, ZHANG X M, et al. Early-phase vascular involvement is associated with acute pancreatitis severity: a magnetic resonance imaging study[J]. Quant Imaging Med Surg, 2021, 11(5): 1909-1920. DOI: 10.21037/qims-20-280.
[25]
BAO Z G, ZHANG X M, CHI X X, et al. Correlation between clinical severity and MR features of acute pancreatitis involving sub-peritoneal spaces[J]. Radiol Pract, 2020, 35(10): 1278-1281. DOI: 10.13609/j.cnki.1000-0313.2020.10.013.
[26]
MANYCH M. Acute pancreatitis-abdominal wall edema on MRI as a complementary indicator of severity[J/OL]. Rofo, 2013, 185(6): 522 [2023-10-13]. https://pubmed.ncbi.nlm.nih.gov/23740703/. DOI: 10.1055/s-0032-1319446.
[27]
ZHOU T, CHEN Y, WU J L, et al. Extrapancreatic inflammation on magnetic resonance imaging for the early prediction of acute pancreatitis severity[J]. Pancreas, 2020, 49(1): 46-52. DOI: 10.1097/MPA.0000000000001425.
[28]
GUPTA P, RANA P, BELLAM B L, et al. Site and size of extrapancreatic necrosis are associated with clinical outcomes in patients with acute necrotizing pancreatitis[J]. Pancreatology, 2020, 20(1): 9-15. DOI: 10.1016/j.pan.2019.11.010.
[29]
FU B, FENG H, GAO F, et al. Role of extrapancreatic necrosis volume in assessing the severity and predicting the outcomes of severe acute pancreatitis[J]. Int J Gen Med, 2021, 14: 9515-9521. DOI: 10.2147/IJGM.S338658.
[30]
KIM Y K, KIM C S, HAN Y M. Role of fat-suppressed t1-weighted magnetic resonance imaging in predicting severity and prognosis of acute pancreatitis: an intraindividual comparison with multidetector computed tomography[J]. J Comput Assist Tomogr, 2009, 33(5): 651-656. DOI: 10.1097/RCT.0b013e3181979282.
[31]
LIN Q, JI Y F, CHEN Y, et al. Radiomics model of contrast-enhanced MRI for early prediction of acute pancreatitis severity[J]. J Magn Reson Imaging, 2020, 51(2): 397-406. DOI: 10.1002/jmri.26798.
[32]
TANG M Y, ZHOU T, MA L, et al. A new logistic regression model for early prediction of severity of acute pancreatitis using magnetic resonance imaging and Acute Physiology and Chronic Health Evaluation Ⅱ scoring systems[J]. Quant Imaging Med Surg, 2022, 12(9): 4424-4434. DOI: 10.21037/qims-22-158.
[33]
KARABUGA B, GEMCIOGLU E, KONCA KARABUGA E, et al. Comparison of the predictive values of CRP, CRP/albumin, RDW, neutrophil/lymphocyte, and platelet/lymphocyte levels in determining the severity of acute pancreatitis in patients with acute pancreatitis according to the BISAP score[J]. Bratisl Lek Listy, 2022, 123(2): 129-135. DOI: 10.4149/BLL_2022_020.
[34]
GUPTA D, MANDAL N S, ARORA J K, et al. Comparative evaluation of harmless acute pancreatitis score (HAPS) and bedside index of severity in acute pancreatitis (BISAP) scoring system in the stratification of prognosis in acute pancreatitis[J/OL]. Cureus, 2022, 14(12): e32540 [2023-10-13]. http://www.ncbi.nlm.nih.gov/pmc/articales/PMC9840061. DOI: 10.7759/cureus.32540.
[35]
COLUOGLU I, COLUOGLU E, BINICIER H C, et al. The role of the BISAP score in predicting acute pancreatitis severity according to the revised Atlanta classification: a single tertiary care unit experience from Turkey[J]. Acta Gastroenterol Belg, 2021, 84(4): 571-576. DOI: 10.51821/84.4.007.
[36]
KAPADIA N N, SIDDIQUI E. Bedside index (BISAP) v/s Ranson scores in predicting mortality and severity in patients with acute pancreatitis[J]. J Pak Med Assoc, 2021, 71(8): 1988-1991. DOI: 10.47391/JPMA.03-417.

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