Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries?
BACKGROUND
We examined patients of blunt trauma with contrast-enhanced multiphasic computed tomography (CT) and determined if it could detect pancreatic duct injuries.


METHODS
During a 17-month period, 95 patients of blunt abdominal trauma underwent multiphasic CT examinations. The CT grading scales of pancreatic injuries at parenchymal phase, portal venous phase, and equilibrium phase were recorded and compared with surgery, endoscopic retrograde cholangiopancreatography, or discharged diagnosis. The diagnostic values of multiphasic CT and interobserver agreements at different phases were computed.


RESULTS
Of the 95 patients, nine (9.5%) had pancreatic injuries (six with main duct injuries, three without main duct injuries). The interobserver agreement presented in kappa values between two radiologists regarding the integrity or disruption of the main duct were good at parenchymal phase (K = 0.73), portal venous phase (K = 0.64), and equilibrium phase (K = 0.68). The overall accuracies of multiphasic CT in detecting main duct injuries were 97.9% (parenchymal phase), 100.0% (portal venous phase), and 96.8% (equilibrium phase), respectively. The sensitivity (50.0%) and negative predictive value (96.7%) of equilibrium phase CT were the lowest among the three phases of CT scans.


CONCLUSIONS
The portal venous phase CT was the most accurate scan to detect pancreatic duct injuries. However, equilibrium phase CT might underestimate major pancreatic injuries. Multiphasic CT shows early promise in this clinical application and further multi-institutional studies to verify its accuracy and reveal the optimal CT methodology are needed.
Wong
Yon-Cheong
YC
Division of Emergency Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. ycwong@cgmh.org.tw
Wang
Li-Jen
LJ
Fang
Jen-Feng
JF
Lin
Being-Chuan
BC
Ng
Chip-Jin
CJ
Chen
Ray-Jade
RJ
D000328:Adult; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol