Comparison of contrast-enhanced CT with diffusion -weighted MRI in the Evaluation of patients with acute biliary pancreatitis

Abstract

INTRODUCTIONAcute pancreatitis progresses on an instable course that has exacerbations and remissions. The mortality rate is between 2.1% and 7.8%. Development of necrosis increases mortality in pancreatitis. In patients with necrosis, the mortality rate increases up to 25% (1, 2). Contrast-enhanced computed tomography (CT) is the most important imaging technique to determine the severity of pancreatitis. However, recent studies suggest that the contrast agent for CT aggravates pancreatitis and provokes organ failure. In addition, the inability to administer contrast to patients with renal dysfunction and contrast allergy causes the disease to be assessed insufficiently (3).Limitations of CT have canalized clinicians to consider different imaging studies. It is believed that diffusion-weighted magnetic resonance imaging (DW MRI) may be compared to and may even replace CT. The severity of acute biliary pancreatitis was evaluated with contrast-enhanced CT and it was compared with DW MRI. MATERIAL AND METHODS PatientsThe patients diagnosed with acute biliary pancreatitis in the Department of General Surgery of İstanbul University by the School of Medicine using DW MRI and MRCP when cholestasis enzyme levels or bilirubin levels were elevated at the time of initial diagnosis were taken for a CT scan within 8 h. The results of two imaging techniques were compared. None of the patients had imaging contraindications such as metallic implant or claustrophobia for DW MRI. The patients' questionnaire included history of hepatic or biliary operations, hepatotoxic drug use, chronic alcohol use, hepatitis B or C carrier status, and suspicion of periam- Objective: The aim of this study was to compare contrast-enhanced computed tomography with diffusion-weighted magnetic resonance imaging in the evaluation of patients with acute biliary pancreatitis. Material and Methods:Fifty-three patients diagnosed with acute biliary pancreatitis, between February 2012 and July 2015, were evaluated using diffusion-weighted magnetic resonance imaging and magnetic resonance cholangiopancreatography to explain the elevation of cholestasis enzymes and bilirubin levels at İstanbul University. Contrast-enhanced computed tomography imaging was applied within 8 h following first evaluation. Demographic data, severity of pancreatitis, pancreatic apparent diffusion coefficient, and computed tomography severity index were compared. The significance of the results was evaluated using Statistical Package for the Social Sciences 21.0 program. Results:Median age was 53.39 (22-90) years in these 53 patients (26 were males and 27 were females). The mean Ranson criterion was 0.96 (0-4) and mean hospitalization duration was 16.02 (3-100) days. Twenty-eight patients were evaluated to have mild acute pancreatitis, whereas 16 were moderately severe and nine were severe based on the Revised Atlanta Classification. Mild pancreatitis score was 0.89, moderately severe pancreatitis score was 3.50, and severe pancreatitis score was 5.78 using the Balthazar score. Eleva...

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Comparison of magnetic resonance imaging and computed tomography in the diagnosis of acute pancreatitis: a systematic review and meta-analysis of diagnostic test accuracy studies

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