An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.
BACKGROUND
Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI).


METHODS
Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled. Preoperative MDCT scans were classified as indicating the presence (+) or absence (-) of PI and PDI. Operative notes were reviewed and all patients were confirmed as PI (+), and then classified as PDI (+) or (-). As all patients had PI, an analysis of PI specificity was not possible. PI patients formed the pool for further PDI analysis. As sensitivity and specificity data were available for PDI, multivariate logistic regression was performed for PDI patients using the presence or absence of agreement between CT and operative note findings as an independent variable. Covariates were age, gender, Injury Severity Score, mechanism of injury, presence of oral contrast, presence of other abdominal injuries, performance of the scan as part of a dedicated pancreas protocol, and image thickness < or =3 mm or > or =5 mm.


RESULTS
Twenty centers enrolled 206 PI patients, including 71 PDI (+) patients. Intravenous contrast was used in 203 studies; 69 studies used presence of oral contrast. Eight-nine percent were blunt mechanisms, and 96% were able to have their duct status operatively classified as PDI (+) or (-). The sensitivity of 16-MDCT for all PI was 60.1%, whereas 64-MDCT was 47.2%. For PDI, the sensitivities of 16- and 64-MDCT were 54.0% and 52.4%, respectively, with specificities of 94.8% for 16-MDCT scanners and 90.3% for 64-MDCT scanners. Logistic regression showed that no covariates were associated with an increased likelihood of detecting PDI for either 16- or 64-MDCT scanners. The area under the curve was 0.66 for the 16-MDCT PDI analysis and 0.77 for the 64-MDCT PDI analysis.


CONCLUSIONS
Sixteen and 64-MDCT have low sensitivity for detecting PI and PDI, while exhibiting a high specificity for PDI. Their use as decision-making tools for the nonoperative management of PI are, therefore, limited.
Phelan
Herb A
HA
UT-Southwestern Medical Center, Dallas, Texas 75390-9158, USA. herb.phelan@utsouthwestern.edu
Velmahos
George C
GC
Jurkovich
Gregory J
GJ
Friese
Randall S
RS
Minei
Joseph P
JP
Menaker
Jay A
JA
Philp
Allan
A
Evans
Heather L
HL
Gunn
Martin L
ML
Eastman
Alexander L
AL
Rowell
Susan E
SE
Allison
Carrie E
CE
Barbosa
Ronald L
RL
Norwood
Scott H
SH
Tabbara
Malek
M
Dente
Christopher J
CJ
Carrick
Matthew M
MM
Wall
Matthew J
MJ
Feeney
Jim
J
O'Neill
Patrick J
PJ
Srinivas
Gujjarappa
G
Brown
Carlos V R
CV
Reifsnyder
Andrew C
AC
Hassan
Moustafa O
MO
Albert
Scott
S
Pascual
Jose L
JL
Strong
Michelle
M
Moore
Forrest O
FO
Spain
David A
DA
Purtill
Mary-Anne
MA
Edwards
Byard
B
Strauss
Jason
J
Durham
Rodney M
RM
Duchesne
Juan C
JC
Greiffenstein
Patrick
P
Cothren
C Clay
CC
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000295:instrumentation*; D014481:United States; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
D003287:Contrast Media