title: Early diagnosis and severity assessment of acute pancreatitis (AP) using MR elastography (MRE) with spin-echo echo-planar imaging.
abstract: To evaluate the accuracy of magnetic resonance elastography (MRE) in comparison to contrast-enhanced computed tomography (CE-CT) for early diagnosis and prediction of severity in acute pancreatitis (AP).
  
  
  
  This cross-sectional prospective study included 76 patients with suspected AP who underwent both CE-CT and 3.0T MRE within 24 hours of hospital admission. Pancreatic stiffness, CT severity index (CTSI), Acute Physiology and Chronic Health Evaluation (APACHE)-II, and Bedside Index for Severity in AP (BISAP) scores were comparatively evaluated using data from the first 24 hours of admission, and diagnosis and severity of AP were confirmed according to the revised Atlanta Classification (2012). The accuracy of MRE for predicting disease severity was compared with that of CE-CT and the clinical scoring systems using area under the receiver-operating curve (AUC) analysis.
  
  
  
  AP was confirmed in 56/76 patients (73.7%). Pancreatic stiffness values of >1.47 kPa showed significantly better diagnostic performance than CE-CT (AUC: 0.993 vs. 0.818, P < 0.001) along with greater sensitivity (96.4% vs. 78.6%, P = 0.006) and accuracy (96.1% vs. 81.6%, P = 0.007). Ten patients (10/76; 13.2%) had clinically severe AP. The accuracy of pancreatic stiffness >2.47 kPa was comparable to that of the CTSI, APACHE-II and BISAP scores for predicting severe AP (accuracy = 85.5%, 75.0%, 88.2%, and 78.9%, respectively). The pairwise comparisons were not significant after Bonferroni correction (P < 0.008 [0.05/6]), with P values of 0.008 (MRE vs. CTSI), 0.823 (MRE vs. APACHE-II) and 0.414 (MRE vs. BISAP).
  
  
  
  Early MRE is a useful, noninvasive method for both diagnosis and early severity assessment of AP. We recommend MRE at hospital admission for initial evaluation of AP.
  
  
  
  1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1311-1319.
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Yan-Qing
authors.initials: YQ
authors.lastname: Liu
authors.affiliation: Department of Hepato-pancreato-biliary Tumour Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Jia-Hui
authors.initials: JH
authors.lastname: Li
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Qiu-Ju
authors.initials: QJ
authors.lastname: Li
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
authors.forename: Qi-Yong
authors.initials: QY
authors.lastname: Guo
mesh_terms: D018806:APACHE; D015746:Abdominal Pain; D000208:Acute Disease; D015992:Body Mass Index; D003287:Contrast Media / Q000737:chemistry*; D003430:Cross-Sectional Studies; D017352:Echo-Planar Imaging; D054459:Elasticity Imaging Techniques; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010343:Patient Admission; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012984:Software; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: MR elastography; acute pancreatitis; computed tomography; diagnosis