Diagnostic Accuracy of Transabdominal Ultrasound and Computed Tomography in Chronic Pancreatitis: A Head-to-Head Comparison

Abstract

Purpose Computed tomography (CT) is the most used imaging modality for diagnosing chronic pancreatitis (CP), but advances in transabdominal ultrasound (US) technology have given US a position as a viable alternative. We aimed to evaluate the diagnostic accuracy of abdominal CT and pancreatic US compared to the reference standard, a modified Mayo score. Materials and Methods CT, US, and endoscopic ultrasound (EUS) were performed in patients referred due to suspected CP. The modified Mayo score included EUS results, clinical presentation, and results from exocrine and endocrine pancreatic function tests. We scored CT findings according to the modified Cambridge classification and US findings according to the Rosemont classification. Results In total, 73 patients were included. 53 patients (73%) were categorized as CP and 20 (27%) as non-CP. CT and US yielded similar sensitivities (68% and 64%, respectively) and specificities (75 and 85%, respectively) and similar areas under the receiver operating characteristic curves for diagnosing CP. We found no significant differences between the areas under the receiver operating characteristic curves (AUROCs) for CT (AUROC 0.75, 95% CI 0.63–0.87) and US (AUROC 0.81, 95% CI 0.71–0.91). Conclusion We conclude that CT and US had comparable, moderate accuracy in diagnosing CP. Neither modality had high enough sensitivity to exclude the diagnosis as a standalone method.

Transabdominal ultrasound for the diagnostic workup of parenchymal pancreatic diseases

“…In a prospective cohort study, the sensitivity of diagnosis based on transabdominal ultrasound was 69 % with a specificity of 97 % [12]. In a direct comparison, similar diagnostic accuracy to that of computed tomography and good agreement with endosonography regarding the assignment of recognized diagnostic scores were seen [13,14]. Since sonographic signs can be very subtle or even absent particularly in the early stages of the disease, a normal ultrasound examination does not rule out chronic pancreatitis.…”

“…In einer prospektiven Kohortenstudie lag die Sensitivität der Diagnosestellung durch den transabdominellen Ultraschall bei 69 %, bei einer Spezifität von 97 % [12]. Im direkten Vergleich zeigten sich eine ähnliche Diagnosegenauigkeit wie in der Computertomografie und eine gute Übereinstimmung mit der Endosonografie hinsichtlich der Einteilung in anerkannte Diagnosescores [13,14]. Da gerade zu Beginn der Erkrankung sonografische Zeichen sehr subtil sein oder gänzlich fehlen können, schließt eine unauffällige Sonografie das Vorliegen einer chronischen Pankreatitis nicht aus.…”