Incorrect estimation of severity of acute pancreatitis by contrast-enhanced computed tomography.
OBJECTIVE
In acute pancreatitis, contrast-enhanced CT is widely accepted to give reliable information in the early assessment of severity. This study critically evaluates the clinical data, outcome, and CE-CT findings in patients with incorrect radiological estimation of the severity of the condition.


METHODS
All patients suspected of having severe pancreatitis underwent contrast-enhanced CT. Clinical data and CE-CT findings of 341 patients were re-examined.


CONCLUSIONS
In 28 patients (8.2%) the radiological diagnosis was inconsistent with the clinical findings. The most common reason--in 20 of the 28 patients (71.4%)--for failure to estimate the severity of pancreatitis was partial necrosis of the gland. In severe cases the partial necrosis was overlooked in nine patients (32.1%). In mild cases clinical significance of partial necrosis--overestimated as representative for the whole gland and technical failure both explained the incorrect interpretation in six (21.4%) patients; and in five patients (17.9%) intermediate patchy enhancement was incorrectly regarded as low. The misleading estimation remained inexplicable in only two (7.1%) patients. These results emphasize adequate assessment of CE-CT and inclusion of all areas of the pancreas in the estimation of enhancement.
Sainio
V S
VS
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Puolakkainen
P A
PA
Kemppainen
E J
EJ
Kivisaari
L
L
Haapiainen
R K
RK
Schröder
T M
TM
Lehtonen
E I
EI
Kivilaakso
E O
EO
D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D014057:Tomography, X-Ray Computed