{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:37:28Z","timestamp":1782272248957,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Infected pancreatic necrosis (IPN) is a major determinant of mortality in acute pancreatitis (AP). Non\u2010invasive diagnosis of IPN could guide the intervention in AP. We aimed to investigate the role of non\u2010invasive methods like diffusion weighted magnetic resonance imaging (DW\u2010MRI) and clinico\u2010laboratory parameters as predictors of IPN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective evaluation for predictors of IPN by diffusion restriction (DR) on DW\u2010MRI and clinico\u2010laboratory parameters was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 39 patients included, 31 were analysed after exclusion. Twenty\u2010six (83.8%) patients had moderately severe AP, and the rest had severe disease. They were categorized into Group A: patients with documented infection after intervention (<jats:italic>n<\/jats:italic>\u2009=\u200917) and Group B: successfully managed without intervention or negative culture after intervention (<jats:italic>n<\/jats:italic>\u2009=\u200914). On univariate analysis, Group A had significantly more incidence of fever (<jats:italic>P<\/jats:italic>\u2009=\u20090.020), persistent unwellness (<jats:italic>P<\/jats:italic>\u2009=\u20090.003), elevated neutrophil count (<jats:italic>P<\/jats:italic>\u2009=\u20090.007), lymphocyte count (<jats:italic>P<\/jats:italic>\u2009=\u20090.007), neutrophil lymphocyte ratio (NLR) (<jats:italic>P<\/jats:italic>\u2009=\u20090.028), DR on DW\u2010MRI (<jats:italic>P<\/jats:italic>\u2009=\u20090.001) and low apparent diffusion coefficient (ADC) (<jats:italic>P<\/jats:italic>\u2009=\u20090.086). Multivariate analysis revealed DR on DW\u2010MRI (<jats:italic>P<\/jats:italic>\u2009=\u20090.004) and NLR (<jats:italic>P<\/jats:italic>\u2009=\u20090.035) as significant predictors of IPN, among other factors. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of DW\u2010MRI were 94.1%, 78.6%, 91.66%, and 84.21%, respectively. The area under curve of NLR on the ROC plot was 0.85 and the best cutoff was &gt;3.5, with sensitivity, specificity, PPV, and NPV of 70.6%, 78.6%, 80%, and 68.7% respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DW\u2010MRI and NLR are promising non\u2010invasive tools for accurate prediction of IPN and hence can guide the need for intervention in acute pancreatitis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.19301","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T07:59:11Z","timestamp":1730793551000},"page":"363-369","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diffusion weighted <scp>MRI<\/scp> and neutrophil lymphocyte ratio non\u2010invasively predict infection in pancreatic necrosis: a pilot study"],"prefix":"10.1111","volume":"95","author":[{"given":"Rommel","family":"Sandhyav","sequence":"first","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation Aster RV Hospital  Bangalore \u2010560078 India"},{"name":"Department of HPB Surgery and Liver Transplantation Institute of Liver and Biliary Sciences  New Delhi \u201070 India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4093-7941","authenticated-orcid":false,"given":"Nihar","family":"Mohapatra","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation Institute of Liver and Biliary Sciences  New Delhi \u201070 India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5331-6701","authenticated-orcid":false,"given":"Nikhil","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplantation Institute of Liver and Biliary Sciences  New Delhi \u201070 India"},{"name":"Department of Gastrointestinal\u2010HPB Surgery and Oncology Max Superspeciality Hospital  New 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