title: Incorrect estimation of severity of acute pancreatitis by contrast-enhanced computed tomography.
abstract: 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.
authors.affiliation: Second Department of Surgery, Helsinki University Central Hospital, Finland.
authors.forename: V S
authors.initials: VS
authors.lastname: Sainio
authors.forename: P A
authors.initials: PA
authors.lastname: Puolakkainen
authors.forename: E J
authors.initials: EJ
authors.lastname: Kemppainen
authors.forename: L
authors.initials: L
authors.lastname: Kivisaari
authors.forename: R K
authors.initials: RK
authors.lastname: Haapiainen
authors.forename: T M
authors.initials: TM
authors.lastname: Schröder
authors.forename: E I
authors.initials: EI
authors.lastname: Lehtonen
authors.forename: E O
authors.initials: EO
authors.lastname: Kivilaakso
mesh_terms: 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