Acute pancreatitis: value of CT in establishing prognosis.

TLDR

Pancreatic necrosis is defined as lack of enhancement of all or part of the gland. Contrast‑enhanced CT was used to quantify necrosis and to create a severity index combining necrosis, peripancreatic inflammation, and phlegmon, which was then linked to clinical outcomes. Patients with necrosis had 23% mortality and 82% morbidity, whereas those without had none; a high CT severity index predicted 92% morbidity and 17% mortality, while a low index predicted 2% morbidity and no deaths.

Abstract

The presence and degree of pancreatic necrosis (30%, 50%, or greater than 50%) was evaluated by means of bolus injection of contrast material and dynamic sequential computed tomography (CT) in 88 patients with acute pancreatitis at initial and follow-up examinations. Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland. Length of hospitalization, morbidity, and mortality in patients with early or late necrosis (22 patients) were evaluated and compared with the same criteria in the rest of the group. Patients with necrosis had a 23% mortality and an 82% complication rate; patients without necrosis had 0% mortality and 6% morbidity. When only the initial assessment was considered, patients with peripancreatic phlegmons and necrosis had 80% morbidity, compared with 36% morbidity in those with phlegmons and no necrosis. Serious complications occurred in patients who initially had or developed more than 30% necrosis. A CT severity index, based on a combination of peripancreatic inflammation, phlegmon, and degree of pancreatic necrosis as seen at initial CT study, was developed. Patients with a high CT severity index had 92% morbidity and 17% mortality; patients with a low CT severity index had 2% morbidity, and none died.