Subscribe to RSS
Enlargement of the Pancreas in Children Diagnosed with Acute Pancreatitis: An Approach Based on P/V Ratio
Background Acute pancreatitis is a reversible inflammation of the pancreatic parenchyma. Enlargement of the pancreas is often envisaged in such conditions. This study evaluates P/V ratio, as a marker to decide pancreatic enlargement in disease condition.
Purpose The aim of this study was to develop imaging-based diagnostic criterion for acute pancreatitis in children based on P/V ratio.
Material and Methods This study included 37 children with acute pancreatitis and 283 children asymptomatic for pancreatic disorders, from a single hospital center. The age of children ranged between 2 and 18 years. P/V ratio, which is the ratio of greatest anteroposterior dimension of the head, body, and tail of the pancreas relative to the transverse lumbar vertebral body, was obtained for each child through ultrasonographic examination. Age-adjusted receiver operating characteristics (AROC) analysis was performed on P/V ratio at presentation for each pancreatic region, and the sensitivity at 90% specificity, the threshold errors, and the corresponding cutoffs were obtained. The enlargement assessment was also done after clinical recovery by referring to the cutoffs of respective regions.
Results AROC analysis for males and females resulted into a maximum sensitivity of 83.33 and 81.67%, respectively, at 90% specificity for head. The error thresholds for both the groups were same, i.e., 0.098, indicating that 90% of the observations had errors less than the threshold. The corresponding P/V ratio cutoff for males and females was 0.43 and 0.42, respectively.
Conclusion Radiologists and clinicians can refer a cutoff value of 0.4 for each region, along with hypoechogenicity, to decide about enlargement of the pancreas in acute pancreatitis condition.
Keywordsacute pancreatitis - acute recurrent pancreatitis - age-adjusted receiver operating characteristics - anteroposterior
Declaration of Patient Consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial Support and Sponsorship
Article published online:
30 August 2022
© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Grzybowska-Chlebowczyk U, Jasielska M, Flak-Wancerz A. et al. Acute pancreatitis in children. Prz Gastroenterol 2018; 13 (01) 69-75
- 2 Uc A, Fishman DS. Pancreatic disorders. Pediatr Clin North Am 2017; 64 (03) 685-706
- 3 Morinville VD, Husain SZ, Bai H. et al; INSPPIRE Group. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012; 55 (03) 261-265
- 4 Werlin SL, Wilschanski M. Acute pancreatitis. In: Kliegman RM, St. Geme J, Blum NJ, Shah SS, Taskar RC, Wilson KM. eds. Nelson Textbook of Pediatrics. Volume 2. 21st ed. United Kingdom: Elsevier; 2020: 2074-2078
- 5 Hebra A, Cuffari C. Pediatric pancreatitis, Overview. 25 Medscape updated 2016, August 15. Available at: https://emedicine.mediscape.com/article/2014039-print
- 6 Kramer C, Jeffery A. Pancreatitis in children. Crit Care Nurse 2014; 34 (04) 43-52 , quiz 53
- 7 Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician 2007; 75 (10) 1513-1520
- 8 Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children?. J Pediatr Gastroenterol Nutr 2011; 52 (03) 262-270
- 9 Abu-El-Haija M, Lin TK, Palermo J. Update to the management of pediatric acute pancreatitis: highlighting areas in need of research. J Pediatr Gastroenterol Nutr 2014; 58 (06) 689-693
- 10 Restrepo R, Hagerott HE, Kulkarni S, Yasrebi M, Lee EY. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. AJR Am J Roentgenol 2016; 206 (03) 632-644
- 11 Abu-El-Haija M, Kumar S, Szabo F. et al; NASPGHAN Pancreas Committee. Classification of acute pancreatitis in the pediatric population: clinical report from the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr 2017; 64 (06) 984-990
- 12 Sonawane BD, Titare PU, Rathod PB, Tembhekar NG, Anand A. Ultrasound assessment of pancreatitis in paediatric adolescent population. Sch J App Med Sci 2014; 2: 3140-3144
- 13 Antunes H, Nascimento J, Mesquita A, Correia-Pinto J. Acute pancreatitis in children: a tertiary hospital report. Scand J Gastroenterol 2014; 49 (05) 642-647
- 14 Darge K, Anupindi S. Pancreatitis and the role of US, MRCP and ERCP. Pediatr Radiol 2009; 39 (Suppl 2): S153-S157
- 15 Khanna PC, Pruthi S. The pancreas. In: Coley BD, Bates DG, Faerber EN, Schulman MH, Kan JH, Lee EY. eds. Caffey's Pediatric Diagnostic Imaging. 12th ed. Philadelphia, PA: Elsevier; 2013: 995-996
- 16 Fleischer AC, Parker P, Kirchner SG, James Jr AE. Sonographic findings of pancreatitis in children. Radiology 1983; 146 (01) 151-155
- 17 Siegel MJ, Martin KW, Worthington JL. Normal and abnormal pancreas in children: US studies. Radiology 1987; 165 (01) 15-18
- 18 Di Giandomenico V, Filippone A, Basilico R, Spinazzi A, Capani F, Bonomo L. Reproducibility of ultrasound measurement of pancreatic size with new advanced high-resolution dynamic image scanners. J Clin Ultrasound 1993; 21 (02) 77-86
- 19 Swobodnik W, Wolf A, Wechsler JG, Kleihauer E, Ditschuneit H. Ultrasound characteristics of the pancreas in children with cystic fibrosis. J Clin Ultrasound 1985; 13 (07) 469-474
- 20 Ueda D. Sonographic measurement of the pancreas in children. J Clin Ultrasound 1989; 17 (06) 417-423
- 21 Winter T, Maryellen RM. The pancreas. In: Rumac C, Levin D. eds. Diagnostic Ultrasound. 5th ed. Elsevier; 2018: 210-228
- 22 Caglar V, Kumral B, Uygur R, Alkoc OA, Ozen OA, Demirel H. Study of volume weight and size of normal pancreas, spleen and kidney in adult autopsies. Forensic Med Anat Res 2014; 2: 63-69
- 23 Danica S, Goran R, Biljana D, Anna U. Traumatic pancreatitis in children. Acad J Pediatr Neonatol 2016; 2: 555588
- 24 Mavrych V, Bolgova O, Ganguly P, Kashenko S. Age-related changes of lumbar vertebral body morphometry. Austin J Anat 2014; 1 (03) 1014
- 25 Raut DS, Raje DV, Dandge VP, Singh D. Percentile reference curves for normal pancreatic dimensions in Indian children. Indian J Radiol Imaging 2018; 28 (04) 442-447