Murat Karul MD, Presenter: Nothing to Disclose

Maxim Avanesov MD, Abstract Co-Author: Nothing to Disclose

Thomas Kraus, Abstract Co-Author: Nothing to Disclose

Thorsten Derlin, Abstract Co-Author: Nothing to Disclose

Gerhard B. Adam MD, Abstract Co-Author: Nothing to Disclose

Jin Yamamura MD, Abstract Co-Author: Nothing to Disclose

To assess the value of multidetector computed tomography (MDCT) in patients with acute pancreatitis and suspected pancreatic necrosis with regard to both lab tests (C-reactive protein, lipase, creatinine) and histopathology.

102 consecutive patients with acute pancreatitis and suspected pancreatic necrosis underwent contrast-enhanced MDCT. Two blinded readers assigned patients into one of three groups (GR). Patients in GR1 showed edematous organ swelling, peripancreatic fluid collection, and pseudocysts; patients in GR2 showed necrotic collection and a lack of pancreatic parenchymal contrast-enhancement; and patients in GR3 had no evidence of pancreatitis. Findings were correlated with results from pancreatic surgery and guided fine-needle aspiration (FNA). Mann-Whitney’s U test was used to evaluate significant differences in lab findings between the groups. Cut-off values were calculated using ROC curve analysis.

Using MDCT, 54/102 patients (52.9%) were classified as GR1, 17/102 patients (16.7%) as GR2, and 31/102 patients (30.4%) as GR3. 13/17 patients (76.5%) in GR2 underwent either surgery (n=6, 46.2%) or FNA (n=7, 53.8%) and pancreatic necrosis was confirmed histopathologically in all of them. Statistical analysis showed significant CRP differences between GR2 vs. GR3 (p=0.001; cut-off point: 82mg/L; AUC 0.76) as well as between GR1 vs. GR3 (p<0.001; cut-off point: 98mg/L; AUC 0.84). The comparison between GR2 vs. GR3 and GR1 vs. GR3 revealed no significantly different lipase (p=0.35; AUC 0.58/p=0.85; AUC 0.52) or creatinine levels (p=0.96; AUC 0.5/p=0.24; AUC 0.6).

In patients with acute pancreatitis, MDCT may help when CRP values are highly elevated to rule out complications such as pancreatic necrosis. In contrast, lipase and creatinine are poor predictors.

Patients with clinically suspected pancreatic necrosis and mild to moderate elevated lab parameters could be saved from unnecessary MDCT examinations.

Karul, M, Avanesov, M, Kraus, T, Derlin, T, Adam, G, Yamamura, J, Patients with Acute Pancreatitis and Suspected Pancreatic Necrosis: When to Perform Computed Tomography?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013856.html