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


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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Acute pancreatitis


Computed tomography (CT)


Magnetic resonance


Endoscopic retrograde cholangiopancreatography


Intensive care unit


Systemic inflammatory response syndrome




Idiopathic acute pancreatitis


Endoscopic ultrasonography


Secretin-stimulated magnetic resonance cholangiopancreatography


Magnetic resonance cholangiopancreatography


Endoscopic retrograde cholangiopancreatography


CT severity index




Common bile duct


Intraoperative cholangiography


Randomized controlled trials


Contrast-enhanced US


Diffusion-weighted imaging


Multidetector CT


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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).

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