Genevieve Nguyen Abbey MD, Presenter: Nothing to Disclose

James S. Babb PhD, Abstract Co-Author: Nothing to Disclose

Emil Jacques Balthazar MD, Abstract Co-Author: Nothing to Disclose

Michael Macari MD, Abstract Co-Author: Nothing to Disclose

The timing of CT in patients with acute pancreatitis is controversial. We sought to determine the utility of CT performed in the ER on patients with acute pancreatitis.

From 1/2007 until 2/2010, 127 patients (80 men, 47 women) mean age 47, presented to our ER with a clinical suspicion of acute pancreatitis and underwent MDCT within 4 hours. MDCT of the abdomen was performed 40 and 80 seconds after 1.5 ml/kg of iodinated contrast material was injected at 3-4 ml/second. The initial CT scans were retrospectively evaluated by two radiologists in consensus to determine initial Balthazar Grade (A-E) and presence of pancreatic necrosis. Our radiology data base was used to determine if subsequent CT was performed. Follow-up imaging was assessed to determine the frequency of changes from initial Balthazar grade as well as subsequent development of necrosis. Fisher’s exact test was used to assess whether a patient was more likely to have follow-up imaging if the initial grade was high (C-E) or was low (A or B).

Of the 127 patients, the initial Balthazar Grade was A=65, B=7, C=42, D= 8, E=5. Four patients demonstrated necrosis on the initial CT (2 with grade C and 2 with grade E). Only 23 (18.1%) of 127 patients underwent follow-up imaging, mean 3 days (range 1-7 days). Of these, 11 of 23 showed no change in Balthazar grade from initial to follow-up scan, 4 (17.4%) showed a decline in grade and 8 (34.8%) showed an increase in grade. Of the 72 patients with an initial grade of A or B, only two underwent follow-up imaging whereas 38.2% (21/55) of those with higher grade pancreatitis (C-E) underwent follow-up imaging. According to Fisher’s exact test, a patient was significantly more likely (p<0.0001) to have follow-up imaging if the initial Balthazar grade was high (C-E) than if it was low (A or B) grade. Of the 23 patients that underwent follow-up imaging, six showed regional pancreatic necrosis that was not present on the initial scan.

CT in the ER is a useful tool in the triage of patients with acute pancreatitis; those with low grade pancreatitis are unlikely to require further imaging while those with higher grade disease may progress and develop necrosis on subsequent imaging.

The vast majority of patients with pancreatitis imaged in the ER do not show progression of disease.

Abbey, G, Babb, J, Balthazar, E, Macari, M, MDCT of Patients with Clinical Pancreatitis in the Emergency Room: Importance of Initial Imaging Findings.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9003123.html