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. 2025 Jul;43(7):1145-1152.
doi: 10.1007/s11604-025-01752-2. Epub 2025 Feb 18.

Arterial phase enhancement of the adrenal glands as a severity indicator for acute pancreatitis

Ryusuke Ookura  1   2 , Noriaki Usuki  3 , Yukio Miki  4
Affiliations

Arterial phase enhancement of the adrenal glands as a severity indicator for acute pancreatitis

Ryusuke Ookura et al. Jpn J Radiol. 2025 Jul.

Abstract

Purpose: To investigate the relationship between the computed tomography (CT) value of the adrenal glands in the arterial phase of dynamic contrast-enhanced CT and the severity of acute pancreatitis.

Materials and methods: We measured the maximum CT values of the adrenal glands on the arterial phase of dynamic contrast-enhanced CT of patients with acute pancreatitis and compared them with those of the non-pancreatitis group. Moreover, we evaluated the correlations between the adrenal CT values and maximum C-reactive protein (CRPmax) and CRP/albumin ratio (CAR) in the clinical courses.

Results: In this retrospective study, a total of 68 patients was included. The maximum CT value of the adrenal glands of pancreatitis group was significantly higher than that of the control group (p < 0.001). Significant fair correlations were observed between the adrenal CT value and CRPmax (r = 0.483, p < 0.001) or CAR (r = 0.450, p < 0.001). The cut-off value of the adrenal CT values was determined as 180.5 Hounsfield unit.

Conclusion: In cases of acute pancreatitis, the maximum CT value of the adrenal gland in the arterial phase of dynamic contrast-enhanced CT was significantly higher than in non-pancreatitis controls, and the intensity of the contrast enhancement correlated with the CRPmax and CAR during the subsequent course of pancreatitis. This finding may assist in predicting the severity of acute pancreatitis.

Keywords: Acute pancreatitis; Adrenal gland; Dynamic contrast-enhanced computed tomography; Intense adrenal enhancement.

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Conflict of interest statement

Declarations. Conflict of interest: The authors did not receive support from any organization for the submitted work. Ethical approval: This study was approved by Ethics Committee of JCHO Osaka Hospital and informed consent was waived due to the retrospective character of the study.

Figures

Fig. 1
Fig. 1
Assignment of region of interest on the bilateral adrenal glands. a right adrenal gland, b left adrenal gland
Fig. 2
Fig. 2
Arterial phase enhancement of the adrenal glands (arrow) of a 55-year-old female of the pancreatitis group (a) and a 55-year-old female of the control group (b). Strong enhancement of the bilateral adrenal glands was observed only in the patient with pancreatitis. MCTSI score of this pancreatitis case was 2 points (mild)
Fig. 3
Fig. 3
The difference in AdrE between patients with and without pancreatitis. The number of patients: 11 cases of 20–39 years, 26 cases of 40–59 years, 23 cases of 60–79 years, and 8 cases of 80 years or older in both groups. Welch’s t-test for 20–39 years age group and Student’s t-test for other age groups. *: p < 0.05
Fig. 4
Fig. 4
All patients plotted by CRPmax (a) and CAR (b). Spearman’s correlation coefficient with AdrE was 0.483 (p < 0.001) for CRPmax and 0.450 (p < 0.001) for CAR. Black circles are the patients who died during the study period
Fig. 5
Fig. 5
ROC analysis to predict CRPmax of 210 mg/L or more (a) and CAR of 6.0 or more (b). AUCs were 0.772 for CRPmax and 0.775 for CAR. The cut-off values are 180.5 HU for both CRPmax and CAR
See this image and copyright information in PMC

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