Yun Robert Sheu MD, MS, Presenter: Nothing to Disclose

Alessandro Furlan MD, Abstract Co-Author: Nothing to Disclose

Amol Patil, Abstract Co-Author: Nothing to Disclose

Omar Almusa MD, Abstract Co-Author: Nothing to Disclose

Georgios I. Papachristou MD, Abstract Co-Author: Nothing to Disclose

Kyongtae Tyler Bae MD, PhD, Abstract Co-Author: Patent agreement, Covidien AG, Saint Louis, MO Patent agreement, Bayer AG, Pittsburgh, PA Expert Advisory Committee, Bracco Group, Princeton, NJ

To assess intra- and extrapancreatic findings (on CT scans performed within 24 hours from the onset of acute pancreatitis) that predict the severity of disease, and to compare accuracies of established CT scores in predicting organ failure.

In a prospective cohort of patients with acute pancreatitis over a 2-year period, 49 patients (25M, 24F, Ages 17-85, Mean 52.5) underwent contrast-enhanced MDCT within 24 hours of disease onset. Severity of pancreatitis was defined as development of multi-system organ failure (OF). Two radiologists in consensus reviewed images and recorded intra-pancreatic findings (e.g., pancreatic inflammation and necrosis, peri-pancreatic fat inflammation and necrosis, intra-and peri-pancreatic fluid collections) and extra-pancreatic findings (e.g., mesenteric inflammation, inflammation surrounding colon and kidney, pleural effusion, peritoneal fluids, and mesenteric vein thrombosis). CT findings were used to calculate the following scores: Balthazar, Pancreatic Severity Index (PSI), CT severity index (CTSI), modified CTSI (mCTSI), and Extrapancreatic Inflammation on CT (EPIC). Chi-square test was used to investigate association between CT findings and OF. Candidate variables (p<.05) were analyzed using multiple logistic regression. ROC curves and areas under the curve (AUC) were calculated to compare performances of CT scores in predicting OF.

11/49 (22%) patients developed OF. Imaging findings associated with OF were: presence of pancreatic necrosis (Odds Ratio=21.6, p=.001), peri-pancreatic fluid collections (OR=7.5, p=.008), pleural effusion (OR=19.9, p<.001) and mesenteric inflammation (OR=8.2, p=.042). Multiple logistic regression analysis revealed that pancreatic necrosis (p=.027) and pleural effusion (p=.012) were the strongest predictor of OF. Calculated AUC for prediction of OF were 0.736 for Balthazar, 0.726 for PSI, 0.819 for CTSI, 0.792 for mCTSI, and 0.818 for EPIC.

Presence of pleural effusion and pancreatic necrosis on early (≤24h) MDCT were the strongest predictor of organ failure associated with acute pancreatitis; and extrapancreatic inflammation on CT (EPIC) and CTSI scores were equally good for predicting organ failure.

As early severe pancreatitis is driven by the systemic inflammatory response, extrapancreatic findings are a critical determinant of the severity of pancreatitis early in the course of the disease.

Sheu, Y, Furlan, A, Patil, A, Almusa, O, Papachristou, G, Bae, K, Early MDCT to Determine Severity of Acute Pancreatitis: Time to Look Outside the Pancreas?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013085.html