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Use of CT and MRI in emergency department patients with acute pancreatitis

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Abstract

Purpose

Assess the utility of CT and MRI in patients with acute pancreatitis (AP) presenting to emergency department (ED).

Materials and Methods

In this Institutional Review Board-approved retrospective study, we identified all patients with AP from March 2012 through February 2013 in ED of a teaching hospital with approximately 60,000 annual visits. Patients were initially identified via ICD-9 code for AP (577.0); diagnosis was confirmed by chart review using established diagnostic criteria (presence of two of the following: typical abdominal pain, elevated lipase/amylase >3 times normal, or imaging findings of pancreatitis). Abdominal CT or MRI obtained in the ED and within 24 h of admission was reviewed by a fellowship-trained abdominal radiologist.

Results

Of 101 patients admitted with AP (60 women, 41 men; mean age 52 years, range 20–89), 63 (62.4%) underwent imaging; only one (1.6%) showed pancreatic necrosis. 88 (87.1%) patients could have been clinically diagnosed without imaging based on presence of abdominal pain and elevated laboratory values; 13 (12.9%) required imaging for diagnosis. Of 88 patients who met AP diagnostic criteria without imaging, 50 (56.8%) nonetheless underwent imaging, with AP without necrosis seen in 34 (68.0%), pancreatic necrosis in one (2.0%), sequelae of prior AP in four (8.0%), and no abnormality in 11 (22.0%).

Conclusion

Early imaging is common in patients with AP, even when the diagnosis can be established based on non-imaging criteria, rarely demonstrating pancreatic necrosis. Reducing overuse of early imaging in patients with confident diagnosis of AP may improve quality and reduce waste.

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Authors and Affiliations

  1. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Atul B. Shinagare, Ivan K. Ip, Ali S. Raja, V. Anik Sahni & Ramin Khorasani

  2. Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 20 Kent Street, 2nd Floor, Brookline, MA, 02445, USA

    Atul B. Shinagare, Ivan K. Ip, Ali S. Raja & Ramin Khorasani

  3. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Ivan K. Ip & Peter Banks

  4. Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Ali S. Raja

Authors
  1. Atul B. Shinagare
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  2. Ivan K. Ip
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  3. Ali S. Raja
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  4. V. Anik Sahni
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  5. Peter Banks
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  6. Ramin Khorasani
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Correspondence to Atul B. Shinagare.

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Shinagare, A.B., Ip, I.K., Raja, A.S. et al. Use of CT and MRI in emergency department patients with acute pancreatitis. Abdom Imaging 40, 272–277 (2015). https://doi.org/10.1007/s00261-014-0210-1

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  • DOI: https://doi.org/10.1007/s00261-014-0210-1

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