CT-Measured Fat & Muscle Parameters: Impact on Acute Pancreatitis Severity

Year 2024, Volume: 7 Issue: 3, 165 - 169, 30.09.2024

Gorkem Ozdemir , Burçak Çakır Peköz , Alper Sözütek , Ahmet Şeker

https://doi.org/10.36516/jocass.1504840

Abstract

Aim: This study investigated whether Computed Tomography (CT)-measured abdominal fat and muscle parameters could improve the accuracy of acute pancreatitis (AP) severity assessment using the CT severity index (CTSI).
Methods: This retrospective study included clinical and imaging parameters of 87 patients with AP. Asan J-Morphometry (Seoul, Korea), an ImageJ-based software (NIH, USA), was used to quantify abdominal muscle and fat areas. Total CTSI score, total fat area (TFA), superficial fat area (SFA), visceral fat area (VFA), total muscle area (MA) and total muscle-fat area (MFA) were calculated. Interreader agreement assessments, univariate and multivariate analyses were performed.
Results:No significant differences were found in CT measurements between groups with or without systemic or local complications, or between groups categorized as mild and severe based on total CTSI scores (p > 0.05 for all comparisons). Surgery, systemic complications, and a high total CTSI score significantly increased the risk of local complications, with odds ratios of 0.001, 141.9, and 2.42, respectively.
With a cutoff of 4 or higher total CTSI score, the diagnostic performance of CTSI in assessing AP severity was as follows: sensitivity 81.25% (95% CI: 63.6-92.8), specificity 49.09% (95% CI: 35.4-62.9), positive predictive value 51% (95% CI: 42.7-59.2), negative predictive value 90% (95% CI: 74.8-96.5), and area under the ROC curve (AUC) 0.72 (95% CI: 0.61-0.81) (p < 0.001). The intraclass correlation coefficients (ICC) were ≥ 0.90 between the readers.
Conclusions: In this study, CT-measured fat and muscle parameters did not significantly improve the accuracy of CTSI in predicting severity of AP.

Keywords

Acute pancreatitis, Atlanta classification, computed tomography, CTSI, fat

Ethical Statement

This retrospective cohort study was approved by the Adana City Training and Research Hospital Clinical Research Ethics Committee, (The project number is 2246, approval date:17.11.2022). authors declare that the study was conducted in accordance with the Declaration of Helsinki and followed the ethical standards of Turkey.

Project Number

The project number is 2246, approval date:17.11.2022

References

• 1.Janisch NH, Gardner TB. Advances in Management of Acute Pancreatitis. Gastroenterol Clin North Am. 2016; 45(1):1-8. https://doi.org/10.1016/j.gtc.2015.10.004
• 2.Ghelfi J, Thony F, Frandon J, et al. Gastrointestinal bleeding due to pancreatitis-induced splenic vein thrombosis: Treatment with percutaneous splenic vein recanalization. Diagn Interv Imaging. 2016; 97(6):677-9. https://doi.org/10.1016/j.diii.2016.01.005
• 3.Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016; 375(20):1972-81. https://doi.org/10.1056/NEJMra1505202
• 4.Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis. Radiology. 1990; 174(2):331-6. https://doi:10.1148/radiology.174.2.2296641
• 5.Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002; 223(3):603-13. https://doi.org/10.1148/radiol.2233010680
• 6.Simchuk EJ, Traverso LW, Nukui Y, et al. Computed tomography severity index is a predictor of outcomes for severe pancreatitis. Am J Surg. 2000; 179(5):352. https://doi.org/10.1016/s0002-9610(00)00375-5
• 7.Valverde-López F, Matas-Cobos AM, Alegría-Motte C, et al. BISAP, RANSON, lactate and others biomarkers in prediction of severe acute pancreatitis in a European cohort. J Gastroenterol Hepatol. 2017; 32(9):1649-56. https://doi.org/10.1111/jgh.13763
• 8.Madico C, Herpe G, Vesselle G, et al. Intra peritoneal abdominal fat area measured from computed tomography is an independent factor of severe acute pancreatitis. Diagn Interv Imaging. 2019; 100(7-8):421-6. https://doi:10.1016/j.diii.2019.03.008
• 9.Monreal-Robles R, Kohn-Gutiérrez AE, Sordia-Ramírez J, et al. Peritoneal cavity circumference on computed tomography predicts outcomes in acute pancreatitis. Eur J Radiol. 2020; 132:109327. https://doi.org/10.1016/j.ejrad.2020.109327
• 10.Schweitzer L, Geisler C, Pourhassan M, et al. What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr. 2015; 102(1):58-65. https://doi.org/10.3945/ajcn.115.111203
• 11.Gupta P, Dawra S, Chandel K, et al. Fat-modified computed tomography severity index (CTSI) is a better predictor of severity and outcome in patients with acute pancreatitis compared with modified CTSI. Abdom Radiol (NY). 2020; 45(5):1350-8.https://doi.org/10.1007/s00261-020-02473-y
• 12.Lin C, Zhang J, Wang C, et al. The impact of skeletal muscle index at the third lumbar spine on nosocomial deterioration and short-term prognosis in acute pancreatitis: a retrospective observational study. PeerJ. 2024;12:e17283. https://doi.org/10.7717/peerj.17283
• 13.Wang S, Wang M, Jiang L, et al. Low skeletal muscle quality extracted from CT is associated with poor outcomes in severe acute pancreatitis patients. Eur J Radiol. 2024;170:111215. https://doi.org/10.1016/j.ejrad.2023.111215
• 14.Fu H, Li P, Xing Q, et al. Cutoff Value of Psoas Muscle Area as Reduced Muscle Mass and Its Association with Acute Pancreatitis in China. Int J Gen Med. 2023;16:2733-51. https://doi.org/10.2147/IJGM.S413308
• 15.Dawra S, Gupta P, Yadav N, et al. Association between the Distribution of Adipose Tissue and Outcomes in Acute Pancreatitis: A Comparison of Methods of Fat Estimation. Indian J Radiol Imaging. 2022; 33(1):12-8. https://doi.org/10.1055/s-0042-1758201
• 16.Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis. Gut. 2005; 54 Suppl 3(Suppl 3):iii1-9. https://doi.org/10.1136/gut.2004.057026 17.Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015; 22(6):405-32. https://doi.org/10.1002/jhbp.259
• 18.Toouli J, Brooke-Smith M, Bassi C, et al; Working Party of the Program Commitee of the Bangkok World Congress of Gastroenterology 2002. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002; 17 Suppl:S15-39. https://doi.org/10.1046/j.1440-1746.17.s1.2.x
• 19. Higaki Y, Nishida T, Matsumoto K, et al. Effect of abdominal visceral fat on mortality risk in patients with severe acute pancreatitis. JGH Open. 2021; 5(12):1357-62. https://doi.org/10.1002/jgh3.12681