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Perfusion CT: Can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis?

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Abstract

Purpose

Pancreatic necrosis is an important determinant of patient outcome in severe acute pancreatitis (SAP). This prospective study was conducted to evaluate if perfusion CT (PCT) can predict the development of necrosis at an early stage in SAP.

Methods

PCT was performed within 72 h of abdominal pain in 57 consecutive admitted patients of acute pancreatitis, out of which four patients were excluded. Thirty-two patients were classified as SAP and 21 as mild acute pancreatitis (MAP) on the basis of APACHE II or SIRS criteria or presence of organ failure. All patients underwent a follow-up CECT at 3 weeks to look for pancreatic necrosis.

Results

Out of 32 patients of SAP, 14 patients showed perfusion defects. The mean blood flow (BF) in these areas was 11.47 ± 5.56 mL/100 mL/min and median blood volume (BV) was 3.92 mL/100 mL (0.5–8.49 mL/100 mL). All these patients developed necrosis on follow-up scan. Two patients who did not show perfusion defects also developed necrosis. Remaining 37 patients (16 SAP and 21 MAP) did not show perfusion defect and did not develop necrosis on follow-up. All regions showing BF less than ≤23.45 mL/100 mL/min and BV ≤8.49 mL/100 mL developed pancreatic necrosis. The values of perfusion parameters may vary with the scanner, mathematical model and protocol used. The sensitivity and specificity of PCT for predicting pancreatic necrosis were 87.5% and 100%, respectively. The cut off values of BF and BV for predicting the development of pancreatic necrosis were 27.29 mL/100 mL/min and 8.96 mL/100 mL, respectively, based on ROC curve.

Summary

PCT is a reliable tool for early prediction of pancreatic necrosis, which may open new avenues to prevent this ominous complication.

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Authors and Affiliations

  1. Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ajay Kumar Yadav, Raju Sharma, Devasenathipathy Kandasamy, Ashu Seith Bhalla, Shivanand Gamanagatti & Deep N. Srivastava

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Ashish Datt Upadhyay

  3. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India

    Pramod Kumar Garg

Authors
  1. Ajay Kumar Yadav
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  2. Raju Sharma
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  3. Devasenathipathy Kandasamy
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Correspondence to Raju Sharma.

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Yadav, A.K., Sharma, R., Kandasamy, D. et al. Perfusion CT: Can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis?. Abdom Imaging 40, 488–499 (2015). https://doi.org/10.1007/s00261-014-0226-6

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