Prevalence of imaging findings of acute pancreatitis in emergency department patients with elevated serum lipase

Daniel I Glazer; Lailah R Cochon; Ali S Raja; David X Jin; Peter A Banks; Aaron D Sodickson; Ramin Khorasani

doi:10.1016/j.ajem.2021.07.015

Prevalence of imaging findings of acute pancreatitis in emergency department patients with elevated serum lipase

Am J Emerg Med. 2021 Dec:50:10-13. doi: 10.1016/j.ajem.2021.07.015. Epub 2021 Jul 9.

Authors

Daniel I Glazer¹, Lailah R Cochon², Ali S Raja³, David X Jin⁴, Peter A Banks⁴, Aaron D Sodickson⁵, Ramin Khorasani⁶

Affiliations

¹ Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America. Electronic address: dglazer@bwh.harvard.edu.
² Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America.
³ Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States of America.
⁴ Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
⁵ Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
⁶ Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Center for Evidence Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 20 Kent Street, Brookline, MA 02445, United States of America.

PMID: 34271230
DOI: 10.1016/j.ajem.2021.07.015

Abstract

Purpose: To assess the association of imaging features of acute pancreatitis (AP) with the magnitude of lipase elevation in Emergency Department (ED) patients.

Methods: This Institutional Review Board-approved retrospective study included 509 consecutive patients presenting from 9/1/13-8/31/15 to a large academic ED with serum lipase levels ≥3× the upper limit of normal (ULN) (≥180 U/L). Patients were excluded if they did not have imaging (n = 131) or had a history of trauma, abdominal metastases, altered mental status, or transfer from an outside hospital (n = 190); the final study population was 188 patients. Imaging exams were retrospectively evaluated, and a consensus opinion of two subspecialty-trained abdominal radiologists was used to diagnose AP. Primary outcome was presence of imaging features of AP stratified by lipase level (≥3×-10× ULN and > 10× ULN). Secondary outcome was rate of discordant consensus evaluation compared to original radiologist's report.

Results: 25.0% of patients (47/188) had imaging features of AP. When lipase was >10× ULN (n = 94), patients were more likely to have imaging features of AP (34%) vs. those with mild elevation (16%) (p = 0.0042). There was moderately strong correlation between lipase level and presence of imaging features of AP (r = 0.48, p < 0.0001). Consensus review of CT and MRI images was discordant with the original report in 14.9% (28/188) of cases.

Conclusion: Prevalence of imaging signs of AP in an ED population with lipase ≥3× ULN undergoing imaging is low. However, the probability of imaging features of AP increases as lipase value increases.

Keywords: Acute pancreatitis; CT; Lipase; MRI.

MeSH terms

Biomarkers / blood
Emergency Service, Hospital*
Female
Humans
Lipase / blood*
Magnetic Resonance Imaging
Male
Middle Aged
Pancreatitis / diagnostic imaging*
Pancreatitis / enzymology*
Prevalence
Retrospective Studies
Tomography, X-Ray Computed

Substances

Biomarkers
Lipase