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Use of Ultrasound to Diagnose & Evaluate the Severity of Pancreatitis in Dogs

Micah A. Bishop, DVM, PhD, DACVIM (SAIM), WAVE Veterinary Internal Medicine, Naples, Florida

Internal Medicine

|April/May 2021

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In the Literature

Cridge H, Sullivant AM, Willis RW, Lee AM. Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis. J Vet Intern Med. 2020;34(2):636-643.


FROM THE PAGE …

Abdominal ultrasonography (AUS) is frequently used to diagnosis pancreatitis, and it is believed that pancreatic ultrasonography can be used to assess severity and possibly help guide clinical treatment. Although it can be challenging to perform ultrasonography on the pancreas, improved training and technology has made this use more common.

The objectives of this retrospective study were to determine whether a correlation exists among AUS findings, specific canine pancreatic lipase assay, and a clinical diagnosis of pancreatitis; whether certain individual AUS abnormalities correlate with a clinical diagnosis of pancreatitis more than others; whether ultrasonographic assessment of pancreatitis severity mirrors clinical severity indexes; whether ultrasonographic assessment of severity over time can be a marker of change in specific canine pancreatic lipase concentration or clinical diagnosis; and the sensitivity and specificity of AUS for diagnosis of canine pancreatitis.

The results suggest that AUS should not be used for determining the severity of pancreatitis. Ultrasound severity indexes were a poor indicator of clinical disease severity; although some findings were associated with pancreatitis, the pancreatic scoring system was poorly correlated with clinical disease indexes of pancreatitis. Ultrasound severity scoring was also poorly correlated with clinical diagnosis (compatible clinical findings, laboratory parameters, and specific canine pancreatic lipase). In addition, changes over time based on ultrasonographic appearance were not correlated with clinical diagnosis.

Although the power of the study was low, the results did not support using ultrasonography to guide pancreatitis treatment and monitoring; however, repeated scans may be useful for determining other causes of worsening abdominal pain (eg, previously unfound foreign body causing secondary pancreatitis) or lack of clinical improvement in a patient that is not responding to therapy.

AUS was of value in detecting decreased echogenicity of the pancreas, pancreatic enlargement, and increased or altered echogenicity of the surrounding mesentery. In isolation, one of these findings is sensitive for clinical diagnosis of pancreatitis but is poorly specific. Specificity increases if 2 or all 3 of these findings are present, but there is decreased sensitivity. These findings may be generally supportive of pancreatitis but should not be used in isolation (ie, without compatible history, physical examination findings, laboratory parameters, and increased specific canine pancreatic lipase concentrations).


… TO YOUR PATIENTS

Key pearls to put into practice:

1

Pancreatic ultrasonography should not be used to assess clinical severity of pancreatitis.

 

2

Serial ultrasonography should not be used to monitor or guide treatment of pancreatitis; however, in patients not responding to therapy, rechecks are important to look for complications or pathology that can cause secondary pancreatitis.

3

Decreased echogenicity of the pancreas, pancreatic enlargement, or alterations/increased echogenicity of the surrounding mesentery can be supportive of a diagnosis of pancreatitis, but none of these findings should be used in isolation to make a diagnosis.

4

A diagnosis of pancreatitis should be based on compatible history, physical examination findings, supportive laboratory parameters, and an increased specific canine pancreatic lipase concentration.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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