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Imaging guidelines for acute pancreatitis: when and when not to image

  • Ana Paola Campos Rocha
  • Khoschy SchawkatEmail author
  • Koenraad J. Mortele
Special Section: Pancreatitis

Abstract

In patients with acute pancreatitis (AP), diagnostic imaging is performed for various reasons, including the detection of the etiology (e.g., biliary obstruction caused by gallstones), diagnosis of pancreatitis in an unclear clinical setting, assessment of the severity of the process, and evaluation of its complications. In spite of the potential benefits of these imaging studies in the setting of AP, especially economic consequences but also medical risks are associated with diagnostic imaging, including increase of the effective radiation dose received by patients with AP and rising health care costs, frequently without impact on management. The rising incidence of acute pancreatitis in the Western world is escalating its financial burden with national health care expenses of over 2.5 billion dollars annually. Despite evidence-based national recommendations on utilization of diagnostic imaging in patients with AP, unnecessary imaging studies are still frequently performed, especially in the early hospital course. The purpose of this article is, therefore, to review the imaging guidelines for acute pancreatitis with regards to when and when not to image, with the aim to minimize inappropriate utilization.

Keywords

Acute pancreatitis Pancreas Guidelines Imaging Cross-sectional imaging Diagnosis 

Abbreviations

AP

Acute pancreatitis

CT

Computed tomography (CT)

MR

Magnetic resonance

ERCP

Endoscopic retrograde cholangiopancreatography

ICU

Intensive care unit

SIRS

Systemic inflammatory response syndrome

US

Ultrasonography

IAP

Idiopathic acute pancreatitis

EUS

Endoscopic ultrasonography

S-MRCP

Secretin-stimulated magnetic resonance cholangiopancreatography

MRCP

Magnetic resonance cholangiopancreatography

ERCP

Endoscopic retrograde cholangiopancreatography

CTSI

CT severity index

GI

Gastrointestinal

CBD

Common bile duct

IOC

Intraoperative cholangiography

RCTs

Randomized controlled trials

CEUS

Contrast-enhanced US

DWI

Diffusion-weighted imaging

MDCT

Multidetector CT

Notes

Acknowledgements

Khoschy Schawkat received a grant from the Swiss National Science Foundation (SNSF) with Grant No. 181917 and Swiss Society of Radiology.

Disclosures

The authors have nothing to disclose.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ana Paola Campos Rocha
    • 1
  • Khoschy Schawkat
    • 1
    • 2
    Email author
  • Koenraad J. Mortele
    • 1
  1. 1.Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Institute of Diagnostic and Interventional RadiologyUniversity Hospital Zurich, University ZurichZurichSwitzerland

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