Utility of the portal venous phase for diagnosing pancreatic necrosis in acute pancreatitis using the CT severity index
The purpose of the study was to evaluate the value of portal venous phase (PVP) images in the diagnosis of pancreatic necrosis in patients with acute pancreatitis using computed tomography severity index (CTSI).
This retrospective study was approved by our Institutional Review Board, and written informed consent was waived. Dynamic contrast-enhanced CT images, with the pancreatic parenchymal phase (PPP) and the PVP, were obtained from 56 consecutive patients with acute pancreatitis. Two radiologists reviewed two sets of images, namely PPP images alone (image set A) and combined PPP and PVP images (image set B) to evaluate the CTSI. Cases were categorized as necrotizing pancreatitis if ensuing walled-off necrosis formation was identified 4 weeks after onset of symptoms. The relationship between pancreatic necrosis and CTSI was compared between image sets A and B. Logistic regression analysis was performed to evaluate the significance of clinical and radiological factors associated with the diagnosis of pancreatic necrosis.
Pancreatic necrosis was confirmed in 14 out of 56 (25%) patients. The area under the receiver-operating-characteristic curve (AUC) for the diagnosis of pancreatic necrosis was 0.70 and 0.78 for image sets A and B, respectively. The AUC for image set B was significantly greater than that for image set A (P = 0.0002). Logistic regression analysis demonstrated that among clinical and radiological factors tested, CTSI for image set B was independently correlated with pancreatic necrosis (P = 0.025).
Combined PPP and PVP images significantly improved the diagnostic accuracy of pancreatic necrosis following acute pancreatitis.
KeywordsPancreatitis Multidetector computed tomography Contrast media Acute necrotizing pancreatitis Diagnostic imaging
Compliance with ethical standards
Conflict of interest
All authors declare relevant conflicts of interest to disclose.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The requirement for informed consent was waived by our Institutional Review Board.
The requirement for informed consent was waived by our Institutional Review Board.
- 8.Hughes SJ, Papachristou GI, Federle MP, Lee KK (2007) Necrotizing pancreatitis. Gastroenterol Clin N Am 36(2):313–323, viii. https://doi.org/10.1016/j.gtc.2007.03.012
- 10.Mortele KJ, Ip IK, Wu BU, et al. (2011) Acute pancreatitis: imaging utilization practices in an urban teaching hospital—analysis of trends with assessment of independent predictors in correlation with patient outcomes. Radiology 258(1):174–181. https://doi.org/10.1148/radiol.10100320 CrossRefPubMedGoogle Scholar
- 21.McNulty NJ, Francis IR, Platt JF, et al. (2001) Multi-detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 220(1):97–102. https://doi.org/10.1148/radiology.220.1.r01jl1897 CrossRefPubMedGoogle Scholar
- 26.Mounzer R, Langmead CJ, Wu BU, et al. (2012) Comparison of existing clinical scoring systems to predict persistent organ failure in patients with acute pancreatitis. Gastroenterology 142(7):1476–1482; quiz e1415–1476. https://doi.org/10.1053/j.gastro.2012.03.005
- 28.Khanna AK, Meher S, Prakash S, et al. (2013) Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg 2013:367581. https://doi.org/10.1155/2013/367581 CrossRefPubMedPubMedCentralGoogle Scholar