Perfusion CT is superior to angiography in predicting pancreatic necrosis in patients with severe acute pancreatitis.
BACKGROUND
We performed perfusion computed tomography (P-CT) and angiography of the pancreas in patients with severe acute pancreatitis (SAP) and compared the usefulness of these two methods in predicting the development of pancreatic necrosis.


METHODS
We compared P-CT and angiography results taken within 3 days after symptom onset in 21 SAP patients. We divided the pancreas into three areas, the head, body, and tail, and examined each area for perfusion defects (via P-CT) and arterial vasospasms (by angiography). Three weeks later, all patients underwent contrast-enhanced CT to determine whether pancreatic necrosis had developed.


RESULTS
Of the 21 SAP patients, 16 exhibited perfusion defects, while 17 proved positive for vasospasms in at least one area. Fourteen patients developed pancreatic necrosis. Of the 63 pancreatic areas from the 21 SAP patients, perfusion defects appeared in 25 areas (39.7%), 24 of which showed vasospasms (96.0%). Angiography showed 33 areas with vasospasms (52.4%), of which 24 showed perfusion defects (72.7%). Of the 25 areas with perfusion defects, 21 developed pancreatic necrosis (84.0%). Of the 33 areas with vasospasms, 21 developed necrosis (63.6%). Pancreatic necrosis developed only in the areas positive both for perfusion defects and for vasospasms. No areas without perfusion defect or vasospasms developed pancreatic necrosis. P-CT predicted the development of pancreatic necrosis with significantly higher accuracy than angiography.


CONCLUSIONS
While both P-CT and angiography are useful in predicting the development of pancreatic necrosis in patients with SAP, P-CT appears to be more accurate for this purpose.
Tsuji
Yoshihisa
Y
Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan.
Hamaguchi
Kyoko
K
Watanabe
Yuji
Y
Okumura
Akira
A
Isoda
Hiroyoshi
H
Yamamoto
Naoki
N
Kikuchi
Osamu
O
Yamamoto
Hiroyuki
H
Matsueda
Kazuhiro
K
Ueno
Kenji
K
Tada
Shinsuke
S
Togashi
Kaori
K
Yamamoto
Hiroshi
H
Chiba
Tsutomu
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000473:pathology; D055420:Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014661:Vasoconstriction