Contrast-enhanced computed tomography in acute pancreatitis: does contrast medium worsen its course due to impaired microcirculation?
BACKGROUND
An early and accurate diagnosis of severe acute (necrotizing) pancreatitis is important to allow timely institution of therapy to limit the extra-pancreatic sequelae of this necrotizing process and to minimize the incidence of super-infection of the necrosis (i.e., progression to infected necrosis). Contrast-enhanced computed tomography (CECT) has become the cornerstone of diagnosis by confirming the clinical diagnosis of severe acute pancreatitis based on the various clinical scoring criteria. Moreover, CECT serves as an anatomic roadmap for guiding radiological and surgical interventions. However, still-controversial experimental studies in animals in the mid-1990s suggested that the use of intravenous radiographic contrast media early in the course of the disease might exacerbate the necrotizing process by further impairing the already compromised pancreatic microcirculation. A series of experimental and clinical studies followed that have both refuted and supported this claim; unfortunately, none is conclusive, and the topic remains, as yet, unresolved.


OBJECTIVE
Our objective was to review objectively the available literature found by a Medline search on this subject.


METHODS
Meta-analysis and review.


CONCLUSIONS
Our conclusion, after analysis of these studies, is that there are no well-substantiated data that could resolve the controversy. However, several caveats will be offered.
Plock
Jan A
JA
Department of Surgery, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland.
Schmidt
Joachim
J
Anderson
Suzanne E
SE
Sarr
Michael G
MG
Roggo
Antoine
A
D000818:Animals; D003287:Contrast Media / Q000009:adverse effects*; D006801:Humans; D008833:Microcirculation / Q000502:physiology; D010179:Pancreas / Q000098:blood supply*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
D003287:Contrast Media