CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy.
Computed tomography (CT) findings that may differentiate walled-off pancreatic necrosis (WOPN) from pancreatic pseudocyst were investigated. CT examinations performed before endoscopic therapy of pancreatic fluid collection (PFC) in 73 patients (45 WOPN, 28 pseudocysts) were evaluated retrospectively by two radiologists. PFC was evaluated for size, extension to paracolic space, characteristics of wall and internal structure. The pancreas was evaluated for deformity or discontinuity, and pancreatic duct dilation. CT findings that were associated with WOPN or pseudocyst were identified. CT score (number of CT findings associated with WOPN minus number of findings associated with pseudocyst) was calculated for each PFC. PFC was categorized as WOPN or pseudocyst using a CT score threshold. Larger size, extension to paracolic space, irregular wall definition, presence of fat attenuation debris in PFC, pancreatic deformity or discontinuity (P < 0.05-0.0001) were findings associated with WOPN. Presence of pancreatic duct dilation was associated with pseudocyst. Using a CT score of 2 or higher as a threshold, CT differentiated WOPN from pseudocyst with an accuracy of 79.5-83.6%. Thus, CT can differentiate WOPN from pseudocysts.
Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA. takahashi.naoki@mayo.edu
Naoki
N
Takahashi
Georgios I
GI
Papachristou
Grant D
GD
Schmit
Prabhleen
P
Chahal
Andrew J
AJ
LeRoy
Michael G
MG
Sarr
Santhi Swaroop
SS
Vege
Jayawant N
JN
Mandrekar
Todd H
TH
Baron
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003937:Diagnosis, Differential; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging* / Q000601:surgery*; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult