Renal Rim Research Articles

A pilot study investigating the feasibility of using a fully automatic software to assess the RENAL and PADUA score.

Image-based morphometric scoring systems such as the RENAL and PADUA scores are useful to evaluate the complexity of partial nephrectomy for renal cell carcinoma (RCC). The main aim of this study was to develop a new imaging software to enable an automatic detection and a 3D visualization of RCC from CT angiography (CTA) and to address the feasibility to use it to evaluate the features of the RENAL and the PADUA scores. A training dataset of 210 patients CTA-scans manually segmented was used to train a deep learning algorithm to develop the automatic detection and 3D-visualization of RCC. A trained operator blindly assessed the RENAL and PADUA scores on a testing dataset of 41 CTA from patients with RCC using a commercialized semi-automatic software (ground truth) and the new automatic software. Concordance between the two methods was evaluated. The median PADUA score was 9 (7-11) and the renal score was 8 (5.5-9). The automatic software enabled to automatically detect the tumoral kidney and provided a 3D-visualization in all cases, with a computational time less than 20 seconds. Concordances for staging the anatomical features of the RENAL scores were respectively: 87.8% for radius, 85.4% for exophytic rate, 82.9% for location to the polar lines and 92.7% for the antero-posterior location. For the PADUA scores, concordances were 90.2% for tumor size, 85.4% for exophytic rate, 87.8% for polar location and 100% for renal rim. By enabling an automatic 3D-visualization of tumoral kidney, this software could help to calculate morphometric scores, save time and improve reproducibility for clinicians.

The Involvement of Renal Capsule Is Associated With Acute Kidney Injury in Patients With Acute Pancreatitis

Background: Acute pancreatitis (AP) is characterized by pancreatic/peripancreatic inflammation. Involvement of renal capsule refers to peripancreatic inflammation extending beyond the Gerota fascia and disappearance of renal rim sign (+) on CT images. However, its association with acute kidney injury (AKI), an important complication of AP, was rarely studied.Aim: This study aimed to assess the relationship between the involvement of renal capsule and AKI in a cohort of patients with AP.Methods: We retrospectively screened all the patients admitted for AP from January 2018 to December 2019. The involvement of renal capsule was judged by experienced radiologists according to the CT imaging. Propensity score matching (PSM) was used to control for biases in group sizes and baseline characteristics. The primary outcome was the development of AKI during the index admission. We also categorized the pararenal inflammation with the renal rim grade (RRG) and compared the incidence of AKI among different grades.Results: Involvement of renal capsule was identified in 71 of 503 patients (14.1%). The incidence of AKI was significantly higher in these patients when compared with the matched controls (43/71, 60.6% vs. 12/71, 16.9%, p < 0.001). Moreover, mortality also differed between groups (12.7% vs. 1.4%, p = 0.017). Multivariable logistic regression showed that renal capsule involvement is an independent risk factor of AKI (odds ratio, 4.355; 95% confidence interval, 1.434, 13.230, p = 0.009). Patients with RRG grade III had a significantly higher incidence of AKI than the other two grades (60.6% for Grade III, 17.1% for Grade II, and 3.8% for Grade I, p < 0.001).Conclusion: Involvement of renal capsule is associated with higher AKI incidence and mortality.

PD16-04 A PILOT STUDY INVESTIGATING THE FEASIBILITY OF USING A FULLY AUTOMATIC SOFTWARE TO ASSESS THE RENAL AND PADUA SCORE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-04 A PILOT STUDY INVESTIGATING THE FEASIBILITY OF USING A FULLY AUTOMATIC SOFTWARE TO ASSESS THE RENAL AND PADUA SCORE Mathieu Carlier, Fabien Lareyre, Cédric Adam, Marion Carrier, Matthieu Durand, and Juliette Raffort Mathieu CarlierMathieu Carlier More articles by this author , Fabien LareyreFabien Lareyre More articles by this author , Cédric AdamCédric Adam More articles by this author , Marion CarrierMarion Carrier More articles by this author , Matthieu DurandMatthieu Durand More articles by this author , and Juliette RaffortJuliette Raffort More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive approaches have demonstrated their interest to improve the peri-operative outcomes during partial nephrectomy for renal cell carcinoma (RCC). Several image-based morphometric scoring systems such as the RENAL and the PADUA scores have been developed to evaluate the complexity of the procedure. Artificial intelligence (AI) has brought new insights in medical imaging analysis, offering the opportunity to perform complex tasks and to develop pattern recognition. We aimed to develop a new imaging software based on AI-techniques to enable an automatic detection and a 3D visualization of RCC from CT scans. This pilot study addressed the feasibility to use it to evaluate the anatomical features included in the RENAL and the PADUA scores. METHODS: The study included patients with RCC who underwent robot-assisted nephrectomy at the University Hospital of Nice between January 2015 and December 2018. Diagnosis of RCC was based on CTA and confirmed by post-operative histopathological examination. Clinical characteristics were collected using manual and electronic medical records. Imaging data were extracted in DICOM format. The pipeline to enable an automatic visualization of RCC consisted in 4 sequential steps: image pre-processing, detection of the kidney using the active contour method, segmentation of the renal vascularization using a hybrid approach combing expert system with deep learning and 3D-viusalization of the tumor kidney. RENAL and PADUA scores were assessed by a trained operator on a semi-automatic commercialized software to serve as a ground truth. Concordance of the staging obtained with the automatic software were blindly assessed by the same operator. RESULTS: In total, 41 CTA from patients with RCC were analysed, with a median age of 66 years (57-70) and 80.5% of men. The median PADUA score assessed with the commercialized software was 9 (7-11) and the renal score was 8 (5.5-9). The automatic pipeline enabled to automatically detect the tumoral kidney and provided a 3D-visualization in all cases, with a computational time less than 20 seconds. Compared to the ground truth, concordances for staging the anatomical features of the RENAL scores were respectively: 87.8% for radius, 85.4% for exophytic rate, 82.9% for location to the polar lines and 92.7% for the antero-posterior location. For the PADUA scores, concordances were 90.2% for tumor size, 85.4% for exophytic rate, 87.8% for polar location and 100% for renal rim. CONCLUSIONS: The automatic software allowed to accurately detect and provide a 3D-visualization of the tumoral kidney in all cases, with a good concordance with the ground truth to assess the RENAL and PADUA scores. By adding further algorithms, this software could be trained to automatically calculate morphometric scores, saving time and improving reproducibility for clinicians. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e279-e279 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mathieu Carlier More articles by this author Fabien Lareyre More articles by this author Cédric Adam More articles by this author Marion Carrier More articles by this author Matthieu Durand More articles by this author Juliette Raffort More articles by this author Expand All Advertisement Loading ...

Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis.

Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis BACKGROUND/AIMS To compare radiological scoring systems, clinical scores, serum C-reactive protein (CRP) levels and the neutrophil-lymphocyte ratio (NLR) for predicting the severity and mortality of acute pancreatitis (AP). MATERIALS AND METHODS Demographic, clinical, and radiographic data from 80 patients with AP were retrospectively evaluated. The harmless acute pancreatitis score (HAPS), systemic inflammatory response syndrome (SIRS), bedside index for severity in acute pancreatitis (BISAP), Ranson score, Balthazar score, modified computed tomography severity index (CTSI), extrapancreatic inflammation on computed tomography (EPIC) score and renal rim grade were recorded. The prognostic performance of radiological and clinical scoring systems, NLR at admission, and serum CRP levels at 48 hours were compared for severity and mortality according to the revised Atlanta Criteria. The data were evaluated by calculating the receiver operator characteristic (ROC) curves and area under the ROC (AUROC). RESULTS Out of 80 patients, 19 (23.8%) had severe AP, and 9 (11.3%) died. The AUROC for the BISAP score was 0.836 (95%CI: 0.735-0.937), with the highest value for severity. With a cut-off of BISAP ≥2, sensitivity and specificity were 68.4% and 78.7%, respectively. The AUROC for NLR was 0.915 (95%CI: 0.790-1), with the highest value for mortality. With a cut-off of NLR >11.91, sensitivity and specificity were 76.5% and 94.1%, respectively. Of all the radiological scoring systems, the EPIC score had the highest AUROC, i.e., 0.773 (95%CI: 0.645-0.900) for severity and 0.851 (95%CI: 0.718-0.983) for mortality, with a cut-off value ≥6. CONCLUSION The BISAP score and NLR might be preferred as early determinants of severity and mortality in AP. The EPIC score might be suggested from the current radiological scoring systems.

CLINICAL COURSE OF FETAL PELVI-CALYCEAL DILATATION DIAGNOSED ON EARLY SECOND TRIMESTER ULTRASOUND.

Aims and Objectives: Incidental finding of fetal pelvi-calyceal dilatation is common finding on early second trimester anomaly scan. [18 to 23 weeks] It causes significant parental anxiety. The present study aims to apply stringent criteria for accurate assessment. It also studies the natural course of such findings, pathological cause for such findings and its postnatal outcomes.&#x0D; Study Design: This study includes 9500 cases that underwent anomaly at 18 to 23 weeks gestation period.&#x0D; &#x0D; The fetal pelvi-calyceal dilatation [PCD] was diagnosed and categorized according to criteria set by European Society for Pediatric Radiology [ 1]. PCD 0 – renal calyces and pelvis not or hardly visible. PCD 1 – renal calyces not visible and axial renal pelvis diameter is less than 7 mm. PCD 2 – some calices are visible but with normal forniceal and papillary shape, axial renal pelvis less than 10 mm. PCD 3 - marked dilatation of calices and pelvis. Pelvic axial width usually more than 10 mm with flattened papilla and rounded fornices but without parenchymal thinning. PCD 4- gross dilatation of entire collecting system and thinning of renal parenchyma. PCD 5- Only thin membrane like residual renal parenchymal rim.&#x0D; &#x0D; Result: Among 9500 women who underwent routine anomaly scan at 18 to 23 weeks gestation, total 390 had PCD findings [4.1 %] Single kidney taken as one case while bilateral findings were taken as 2 cases.&#x0D; 98 [25.1 %] pregnancies had bilateral PCD findings and rest 292[74.9%] had unilateral PCD changes. These findings correlate well with as shown by S Sairam et al, Livera et al, Gunn et al [2, 3, 4] &#x0D; PCD 1 findings were noted in 317 cases, PCD2 findings were noted in 38 cases, PCD3 findings in 23 cases and PCD4 findings in 12 cases. All these fetuses were followed till either PCD findings resolved naturally or till 2 years of their life. These findings also compare well with S Sairam et al, and Persutte et al [ 2, 5]&#x0D; About 00 cases of PCD1, 3 cases of PCD2 and 2 cases of PCD3 were lost for follow up for various reasons.&#x0D; Two cases of PCD1 were lost due to additional diagnosis of Down syndrome in one case and multiple anomalies in other cases. Both were excluded from the present study.&#x0D; Rest of them [383] were studied and analyzed for this paper.&#x0D; Out of 315 PCD1 cases, all turned out to be normal&#x0D; Out of 35 PCD2 cases, 19 were resolved, 12 remain unchanged at second year of child age rest were&#x0D; 4 worsened&#x0D; Out of 21 PCD 3, 2 cases resolved spontaneously, 5 remain unchanged and 14 cases worsened&#x0D; Out of 12 PCD 4 cases, all needed and underwent surgical intervention. 04 kidneys were saved and rest 8 had nephrectomies.

ARE PATIENTS WITH DIABETIC NEPHROPATHY DIFFERENT REGARDING RENAL ULTRASOUND PARAMETERS AND DOPPLER SONOGRAPHY FINDINGS COMPARED WITH RENAL HISTOPATHOLOGY?

Ultrasonography (US) findings and Doppler sonography of renal vessels can provide useful information on the structural and vascular supply of patients suffering from chronic kidney disease (CKD). The purpose of this study was to compare the US findings of patients with diabetic nephropathy with the pathologic findings of their renal biopsy. In this descriptive study, US parameters including resistivity index (RI), renal size and volume and cortical and medullary echogenicity, and histopathological findings of renal biopsy (fibrosis, inflammation and chronicity) of 60 patients (27 women and 33 men) with diabetic nephropathy admitted in Hasheminejad kidney center (HKC) of Tehran were extracted and analyzed. Of 60 patients, interstitial fibrosis (IF) in 47 patients, interstitial inflammation (II) in 50 patients and signs of chronicity in 43 patients in pathology report were observed. Patients with IF had larger renal length, higher sinus volume, coarse echogenicity, and abnormal medullary echogenicity, significantly. The presence of II was associated with larger renal length, higher renal and sinus volume, higher cortical echogenicity, and more patients with coarse echogenicity and abnormal medullary echogenicity. The observation of chronicity was significantly correlated with higher sinus volume and more patients with irregular renal rim. According to the findings of this study, renal length and volume, renal sinus volume, and the presence of coarse echogenicity and abnormal medullar echogenicity strongly correlate with renal histopathologic findings in patients with diabetic nephropathy. RI is not a suitable marker for identifying tubulointerstitial changes in these patients.

The Value of Modified Renal Rim Grade in Predicting Acute Kidney Injury Following Severe Acute Pancreatitis.

To retrospectively determine the value of modified renal rim grade (MRRG) in predicting acute kidney injury (AKI) in the early phase of severe acute pancreatitis (SAP). This institutional review board-approved retrospective study included patients with SAP who underwent abdominal contrast-enhanced computed tomography (CT) within 48 hours after disease onset. Modified renal rim grade, renal rim grade, CT severity index, modified CT severity index, extrapancreatic inflammation on CT scores, and posterior pararenal (PPR) space involvement were assessed. Clinical data, including bedside index of severity in acute pancreatitis and New Japanese Severity Scoring system scores, were collected. Primary end points were AKI and mortality. Scores were evaluated by receiver operating characteristic curve analysis. Correlational analyses between MRRG scores and the other scores were performed with Spearman analysis. One hundred five consecutive patients were enrolled in our study. The areas under the curve (AUCs) of MRRG in predicting AKI (0.90) and mortality (0.83) were comparable to extrapancreatic inflammation on CT (0.89 and 0.85, P > 0.05) and were higher than those of the other CT scores (P < 0.05). Modified renal rim grade score of greater than 4 yielded sensitivities and specificities of 81% and 89% for predicting AKI and 88% and 66% for mortality. Modified renal rim grade correlated moderately with bedside index of severity in acute pancreatitis (Spearman r = 0.47) and New Japanese Severity Scoring system (r = 0.43) scores. Besides, the prevalence of PPR space involvement in nonrecovery AKI patients was higher than that in recovery patients (94% vs 36%, P < 0.05). Modified renal rim grade is well correlated with the occurrence of AKI and mortality in SAP. The PPR space involvement is a promising prognostic factor for nonrecovery of AKI in SAP patients.

Nephrometry scores and perioperative outcomes following robotic partial nephrectomy.

ABSTRACTObjectives:Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy. However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes.Materials and Methods:We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR.Results:The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months.Conclusions:Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.

Role of Renal Doppler Flowmetry in Patients with Altered Renal Function Tests

Objectives: (i) Study was done to know the sensitivity of renal ultrasound with Doppler studies in patient with altered renal function test. (ii) To study the sonomorphological characteristics in grayscale ultrasound and renal Doppler flowmetry in altered renal function test. Material and Methods: A hospital based cross sectional study of 83 patients were conducted over a period of 1 year from June 2013 to May 2014 in the Deptt. Radio Daignosis, Assam Medical College & Hospital Dibrugarh. Approved was obtained from Institutional ethics review committees, AMCH, Dibrugarh. All the patients are subjected to grey scale USG of abdomen and Renal Doppler study. Grey scale USG done with 2.5-5 MHz curvilinear transducer and 10 MHz linear transducer. Both colour Doppler and pulsed wave Doppler mode were done by using 2.5-5 MHz convex array probe. Result: For the analysis of the study, group is subdivided into four subgroups e.g. (i) Chronic kidney disease (CKD) (ii) Acute kidney Injury (AKI) (iii) Glomerular dieases – Nephritic Syndrome (NeS) & Nephrotic Syndrome (NS) (iv) Lupus Nephritis (LN). Among the 93 patients CKD 68 (73%), AKI – 13(12.9%) Nes- 3(3.2%), NS- 6 (6.4%), LN – 4 (4.3%). Renal length are reduced 19%, increased in 16%. Renal cortical echoes are increased in 66.6%. In Renal Doppler RIm is increased 72 (77%) patients. PSVa were normal in 82.7% and increased 17% patients. Conclusion: Renal Doppler USG can delineate altered renal function tests in medical renal disease. USG features like increased renal cortical echotexture, increased and decreased renal size, irregular renal surface are the useful indicators for altered renal function. Keyword: USG, Renal Doppler flowmetry, altered Renal Function.

Mo1323 Extra Pancreatic Inflammation on Computed Tomography and Severity of Acute Pancreatitis: Comparison of Extra Pancreatic Inflammation on CT (EPIC) Score With BISAP, SIRS, Renal Rim, CTSI, and MCTSI Scoring Systems

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

Mo1324 Idiopathic Recurrent Acute Pancreatitis (IRAP) and Diminished Parenchymal Radiodensity on Interval Non-Contrast CT Scan (NCT). Is Increased Intraparenchymal Pancreatic Fat (IPF) Content Associated With iRAP?

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

Mo1325 Patterns of Alcohol and Tobacco Use in a Prospective Cohort: Alcohol Is Associated With Organ Failure and Necrosis in Sentinel Acute Pancreatitis

Introduction: A number of scoring systems have been developed to predict the prognosis of acute pancreatitis (AP). Extra pancreatic inflammation as evident by pleural effusion, ascites, and retroperitoneal fluid collections has been shown to be an important marker of severity. Aim: To compare EPIC scoring system with BISAP, SIRS, CTSI and MCTSI and Renal rim grade scoring systems in predicting persistent organ failure (POF), intervention and mortality in AP. Patients and Methods: The demographic, radiographic, and laboratory data from consecutive patients with AP admitted in our unit over last 14 months were retrospectively evaluated. The SIRS, BISAP, CTSI, MCTSI, Renal rim grade and the EPIC score (based on the presence of pleural effusion, ascites, and retroperitoneal and mesenteric inflammation) were calculated for all the patients. The scores were evaluated by calculating receiver operator characteristic (ROC) curves and the area under the ROC curve. Results: One hundred and five patients (65 males; mean age 40.6± 12.9 years) with AP were included in the study. Eight patients died and 71 patients developed POF whereas radiological/ endoscopic intervention were needed in 16 patients. The mean CTSI, MCTSI and EPIC score were 5.8 ± 3.0, 7.1 ± 2.6 and 4.0 ± 1.9 respectively. The area under curves (AUC) for SIRS, BISAP, CTSI, MCTSI, Renal Rim Score and EPIC score in predicting POF were 0.65 (CI: 0.53-0.78), 0.75 (CI: 0.65-0.86), 0.66 (CI: 0.54-0.78), 0.70 (CI: 0.58-0.81), 0.64 (0.52-0.76), 0.71 (CI: 0.60-0.83) respectively, for radiological/endoscopic intervention were 0.50 (CI: 0.35-0.65), 0.64 (CI: 0.49-0.78), 0.51 (CI: 0.36-0.66), 0.55 (CI: 0.41-0.70),0 .51 (0.36-0.67), 0.66 (CI: 0.52-0.81) respectively, and for mortality 0.57 (CI: 0.38-0.75), 0.90 (CI: 0.83-0.97), 0.67 (CI: 0.50-0.83), 0.68 (CI: 0.51-0.85), 0.73 (CI: 0.57-0.89) and 0.77 (CI: 0.64-0.90) respectively. Conclusion: The predictive assessment of radiological scoring systems for POF, need for intervention and mortality is similar to clinical scoring systems. EPIC score is superior to other radiological scoring systems in predicting endoscopic/radiological intervention.

“Renal Rim Sign”

“Renal Rim Sign”

Significance of Renal Rim Grade on Computed Tomography in Severity Evaluation of Acute Pancreatitis

Multifactor scoring systems, such as the Acute Physiology and Chronic Health Evaluation (APACHE) II, are useful for predicting the severity of acute pancreatitis (AP); however, they are rather complicated. The aim of this study was to introduce renal rim grade (RRG) as a severity assessment measure for AP. One hundred twenty-two eligible AP patients who underwent abdominal computed tomography (CT) on admission were evaluated for RRG (grades 1-3). The end points were the severity of illness and hospital mortality. Furthermore, RRG was compared with the Balthazar score, the CT severity index, the Ranson score, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score, using a receiver operating characteristic analysis. The exacerbation rates into severe disease were 3% (grade 1), 48% (grade 2), and 89% (grade 3). The mortality rates were 3% (grade 1), 8% (grade 2), and 31% (grade 3). The area under the receiver operating characteristic curves to predict the severe disease and mortality using the RRG system were comparable with other scoring systems. Renal rim grade is useful for the evaluation of the severity of AP.