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

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.

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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

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Acknowledgements

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

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Rocha, A.P.C., Schawkat, K. & Mortele, K.J. Imaging guidelines for acute pancreatitis: when and when not to image. Abdom Radiol 45, 1338–1349 (2020). https://doi.org/10.1007/s00261-019-02319-2

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Keywords

  • Acute pancreatitis
  • Pancreas
  • Guidelines
  • Imaging
  • Cross-sectional imaging
  • Diagnosis