Acute Pancreatitis

Part of the Medical Radiology book series (MEDRAD)


Acute pancreatitis is an inflammatory disease that is mild and resolves without serious morbidity in 80% of patients. In the remaining 20%, it is complicated by substantial morbidity and mortality. The early distinction of these two groups of patients is desirable, as it is essential for their proper management. Even though positive diagnosis of acute pancreatitis is based on clinical and biological data, imaging, especially abdominal multidetector computed tomography (MDCT), has a key role in the initial phases of the disease. It allows the establishment of radiologic scoring systems with the aim of predicting which patients will have a severe debilitating hospital course and which patients will recover without major physiologic insult. The time of realization and the technique of MDCT are presently well defined. In the initial phase of the disease, MDCT allows firstly assessment of extension of initial lesions (pancreatic necrosis and fluid collections) and secondly depiction of early complications. Later, MDCT in association with MRI contributes to the etiological diagnosis and to the detection of late complications. Moreover, MDCT is helpful to plan and perform the treatment of the complications.


Acute Pancreatitis Pancreatic Duct Fluid Collection Compute Tomography Examination Severe Acute Pancreatitis 
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  1. Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, Jeanmart J, Zalcman M, Van Gansbeke D, Devière J, Matos C (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 126:715–723PubMedCrossRefGoogle Scholar
  2. Arvanitakis M, Koustiani G, Gantzarou A, Grollios G, Tsitouridis I, Haritandi-Kouridou A, Dimitriadis A, Arvanitakis C (2007) Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging—a comparative study. Dig Liver Dis 39:473–482PubMedCrossRefGoogle Scholar
  3. Balthazar EJ, Ranson JHC, Naidich DP et al (1985) Acute-pancreatitis—prognostic value of CT. Radiology 3:767–772Google Scholar
  4. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (1990) Acute pancreatitis: value of CT in establishing prognosis. Radiology 2:331–336Google Scholar
  5. Cannon JW, Callery MP, Vollmer CM Jr (2009) Diagnosis and management of pancreatic pseudocysts: what is the evidence? J Am Coll Surg 209(3):385–393PubMedCrossRefGoogle Scholar
  6. Carroll JK, Herrick B, Gipson T, Lee SP (2007) Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician 10:1513–1520Google Scholar
  7. Casas JD, Diaz R, Valderas G, Mariscal A, Cuadras P (2004) Prognostic value of CT in the early assessment of patients with acute pancreatitis. AJR Am J Roentgenol 3:569–574Google Scholar
  8. De Madaria E, Soler-Sala G, Lopez-Font I, Zapater P, Martínez J, Gómez-Escolar L, Sánchez-Fortún C, Sempere L, Pérez-López J, Lluís F, Pérez-Mateo M (2010) Update of the Atlanta classification of severity of acute pancreatitis: should a moderate category be included. Pancreatology 10(5):613–619CrossRefGoogle Scholar
  9. De Waele JJ, Delrue L, Hoste EA et al (2007) Extrapancreatic inflammation on abdominal computed tomography as an early predictor of disease severity in acute pancreatitis—evaluation of a new scoring system. Pancreas 2:185–190CrossRefGoogle Scholar
  10. Delrue LJ, De Waele JJ, Duyck PO (2010) Acute pancreatitis: radiologic scores in predicting severity and outcome. Abdom Imaging 35(3):349–361PubMedCrossRefGoogle Scholar
  11. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. AJR Am J Roentgenol 170(4):969–975PubMedGoogle Scholar
  12. Frossard JL, Steer ML, Pastor CM (2008) Acute pancreatitis. Lancet 371(9607):143–152PubMedCrossRefGoogle Scholar
  13. Habib E, Elhadad A, Slama JL (2000) Diagnosis and treatment of spleen rupture during pancreatitis. Gastroenterol Clin Biol 24(12):1229–1232PubMedGoogle Scholar
  14. Johnson C, Lévy P (2010) Detection of gallstones in acute pancreatitis: when and how? Pancreatology 10(1):27–32PubMedCrossRefGoogle Scholar
  15. Kim YH, Saini S, Sahani D, Hahn PF, Mueller PR, Auh YH (2005) Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. Radiographics 25(3):671–685PubMedCrossRefGoogle Scholar
  16. King NK, Powell JJ, Redhead D, Siriwardena AK (2003) A simplified method for computed tomographic estimation of prognosis in acute pancreatitis. Scand J Gastroenterol 4:433–436CrossRefGoogle Scholar
  17. Kirby JM, Vora P, Midia M, Rawlinson J (2008) Vascular complications of pancreatitis: imaging and intervention. Cardiovasc Intervent Radiol 31(5):957–970PubMedCrossRefGoogle Scholar
  18. Lankisch PG, Assmus C, Pflichthofer D, Struckman K, Lehnick D (1999) Which etiology causes the most severe pancreatitis? Int J Pancreat 26:55–57CrossRefGoogle Scholar
  19. Lankisch PG, Struckmann K, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB (2001) Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis? Scand J Gastroenterol 36(4):432–436PubMedCrossRefGoogle Scholar
  20. Lau ST, Simcuck EJ, Kozarek RA, Traverso W (2001) A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg 181:411–417PubMedCrossRefGoogle Scholar
  21. London NJ, Neoptolemos JP, Lavelle J, Bailey I, James D (1989) Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: a prospective study. Br J Surg 3:268–272CrossRefGoogle Scholar
  22. Loveday BP, Mittal A, Phillips A, Windsor JA (2008) Minimally invasive management of pancreatic abscess, pseudocyst, and necrosis: a systematic review of current guidelines. World J Surg 32(11):2383–2394PubMedCrossRefGoogle Scholar
  23. Maher MM, Lucey BC, Gervais DA, Mueller PR (2004) Acute pancreatitis: the role of imaging and interventional radiology. Cardiovasc Intervent Radiol 27(3):208–225PubMedCrossRefGoogle Scholar
  24. Maringhini A, Uomo G, Patti R et al (1999) Pseudocysts in acute nonalcoholic pancreatitis: incidence and natural history. Dig Dis Sci 44:1669–1673PubMedCrossRefGoogle Scholar
  25. McKay CJ, Buter A (2003) Natural history of organ failure in acute pancreatitis. Pancreatology 2:111–114CrossRefGoogle Scholar
  26. Mortelé KJ, Wiesner W, Intriere L et al (2004) A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol 5:1261–1265Google Scholar
  27. Nøjgaard C, Bendtsen F, Matzen P, Becker U (2010) The aetiology of acute and chronic pancreatitis over time in a hospital in Copenhagen. Dan Med Bull 57(1):A4103PubMedGoogle Scholar
  28. Papachristou GI, Clermont G, Sharma A, Yadav D, Whitcomb DC (2007) Risk and markers of severe acute pancreatitis. Gastroenterol Clin N Am 2:277–296CrossRefGoogle Scholar
  29. Pastor CM, Matthay M, Frossard JL (2003) Pancreatitis-associated lung injury: new insights. Chest 124:2341–2351PubMedCrossRefGoogle Scholar
  30. Pitchumoni CS, Rubin A, Das K (2010) Pancreatitis in inflammatory bowel diseases. J Clin Gastroenterol 44(4):246–253PubMedCrossRefGoogle Scholar
  31. Sahani DV, Kalva SP, Farrell J, Maher MM, Saini S, Mueller PR, Lauwers GY, Fernandez CD, Warshaw AL, Simeone JF (2004) Autoimmune pancreatitis: imaging features. Radiology 233(2):345–352PubMedCrossRefGoogle Scholar
  32. Sandrasegaran K, Tann M, Jennings SG, Maglinte DD, Peter SD, Sherman S, Howard TJ (2007) Disconnection of the pancreatic duct: an important but overlooked complication of severe acute pancreatitis. Radiographics 27(5):1389–1400PubMedCrossRefGoogle Scholar
  33. Schmidt J, Hotz HG, Foitzik T et al (1995) Intravenous contrastmedium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat. Ann Surg 3:257–264CrossRefGoogle Scholar
  34. Takahashi N, Papachristou GI, Schmit GD, Chahal P, LeRoy AJ, Sarr MG, Vege SS, Mandrekar JN, Baron TH (2008) CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy. Eur Radiol 18(11):2522–2529PubMedCrossRefGoogle Scholar
  35. Ueda T, Takeyama Y, Yasuda T et al (2007) Simple scoring system for the prediction of the prognosis of severe acute pancreatitis. Surgery 1:51–58CrossRefGoogle Scholar
  36. Van Minnen LP, Besselink MG, Bosscha K, Van Leeuwen MS, Schipper ME, Gooszen HG (2004) Colonic involvement in acute pancreatitis. A retrospective study of 16 patients. Dig Surg 21(1):33–38PubMedCrossRefGoogle Scholar
  37. Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ (2005) Computed tomography severity index is an early prognostic tool for acute pancreatitis. J Am Coll Surg 4:497–502CrossRefGoogle Scholar
  38. Vullierme MP, Giraud M, Hammel P, Couvelard A, Sauvanet A, Belghiti J, Ruszniewski P, Vilgrain V (2005) Intraductal papillary mucinous tumours of the pancreas: imaging features. J Radiol 86(6 Pt 2):781–794PubMedCrossRefGoogle Scholar
  39. Wada K, Takada T, Hirata K, Mayumi T, Yoshida M, Yokoe M, Kiriyama S, Hirota M, Kimura Y, Takeda K, Arata S, Hirota M, Sekimoto M, Isaji S, Takeyama Y, Gabata T, Kitamura N, Amano H (2010) Treatment strategy for acute pancreatitis. J Hepatobiliary Pancreat Sci 17(1):79–86PubMedCrossRefGoogle Scholar
  40. Whitcomb DC (2006) Acute pancreatitis. N Engl J Med 20:2142–2150CrossRefGoogle Scholar
  41. Xiao B, Zhang XM, Tang W, Zeng NL, Zhai ZH (2010) Magnetic resonance imaging for local complications of acute pancreatitis: a pictorial review. World J Gastroenterol 16(22):2735–2742PubMedCrossRefGoogle Scholar
  42. Yadav D, Lowenfels AB (2006) Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas 33:323–330PubMedCrossRefGoogle Scholar
  43. Yeo CJ, Bastidas JA, Lynch-Nyhan A et al (1990) The natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 170:411–417PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Radiologie ACentre HospitalierAngersFrance

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