Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis.
OBJECTIVE
To evaluate dynamic contrast enhanced computed tomography for detecting and localising pancreatic necrosis in acute pancreatitis.


METHODS
Prospective evaluation with blind reporting of scans.


METHODS
Single teaching hospital.


METHODS
60 Consecutive patients with acute pancreatitis suspected to have pancreatic necrosis because of major organ system failure (13); slow recovery five to seven days after admission with raised scores on the acute physiological and chronic health evaluation (APACHE-II) system (27); or findings on previous ultrasonography or computed tomography (20).


METHODS
Pancreatic necrosis proved histologically--that is, greater than 30 g necrotic tissue debrided at laparotomy (for life threatening sepsis or peritonitis) or necropsy.


RESULTS
Dynamic computed tomography correctly localised pancreatic necrosis in 11 patients (confirmed at laparotomy in nine and at necropsy in two). Of nine patients with low enhancement of peripancreatic tissues alone, eight recovered after conservative management; necropsy confirmed viable pancreas and necrosis of peripancreatic fat in one patient. Of 40 patients with normal contrast enhancement, none required laparotomy to debride pancreatic necrosis.


CONCLUSIONS
Dynamic contrast enhanced computed tomography seems to be a safe and accurate method of identifying and localising pancreatic and peripancreatic necrosis, which cannot be predicted accurately by conventional imaging techniques.
Larvin
M
M
University Department of Surgery, General Infirmary, Leeds.
Chalmers
A G
AG
McMahon
M J
MJ
D000208:Acute Disease; D006801:Humans; D009336:Necrosis; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D011856:Radiographic Image Enhancement; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*