Perfusion-CT - Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

Abstract

PurposeSevere acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.Material and Methods79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4–6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.ResultsStatistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.ConclusionsCT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.

Predictive factors for the mortality of acute pancreatitis on admission

“…Pancreatic necrosis is one of the triggers of persistent OF; therefore, detecting it accurately and early may predict the onset of persistent OF. In recent years, perfusion CT has been reported to be useful in predicting early stage pancreatic necrosis (sensitivity, 88–100%; specificity, 84–100%) [18–20]. However, perfusion CT requires specific equipment and it is not available at all institutions currently.…”

Prediction of the progression of walled‐off necrosis in patients with acute pancreatitis on whole pancreatic perfusion CT

“…Although AP is a benign disease, the mortality rate in SAP still remains high, reaching 15%-25%. 1 In 2012, the revised Atlanta classification was published, and AP was subdivided into two types: interstitial edematous pancreatitis and necrotizing pancreatitis. 3 13 Thus, it is important to detect pancreatic ischemia early in AP.…”

“…We decided to measure the ROI at more than three locations each for the pancreatic head, body, and tail with reference to previous literature. 1 The ROI was measured by sliding the whole pancreas for a total of 15-20 points depending on each patient, avoiding blood vessels. Besides, The ROI setting was decided not only by us but also by the radiologists.…”

“…The number of SAP and CE-CT grades in the WON group was significantly higher than in the without WON group. However, the minimum CT value did not differ significantly between the two groups, though many articles recommended that pancreatic necrosis should be detected by CE-CT. 1 The diagnosis of pancreatic necrosis by CE-CT is qualitative, so that the diagnosis might depend on the subjective interpretation of the physicians. On the other hand, the minimum PBV and the PBV ratio of the minimum and maximum were significantly lower in the WON group than in the without WON group.…”

Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease?

“…Patients' recruitment criteria in this study were the same as in our previously published work on pancreatic perfusion [50]. All 41 patients, who after control CT carried out of the pancreas after 4-6 days from the onset of symptoms revealed progression of the disease, were included in the study.…”