title: Use of CT and MRI in emergency department patients with acute pancreatitis.
abstract: OBJECTIVE
  Assess the utility of CT and MRI in patients with acute pancreatitis (AP) presenting to emergency department (ED).
  
  
  METHODS
  In this Institutional Review Board-approved retrospective study, we identified all patients with AP from March 2012 through February 2013 in ED of a teaching hospital with approximately 60,000 annual visits. Patients were initially identified via ICD-9 code for AP (577.0); diagnosis was confirmed by chart review using established diagnostic criteria (presence of two of the following: typical abdominal pain, elevated lipase/amylase >3 times normal, or imaging findings of pancreatitis). Abdominal CT or MRI obtained in the ED and within 24 h of admission was reviewed by a fellowship-trained abdominal radiologist.
  
  
  RESULTS
  Of 101 patients admitted with AP (60 women, 41 men; mean age 52 years, range 20-89), 63 (62.4%) underwent imaging; only one (1.6%) showed pancreatic necrosis. 88 (87.1%) patients could have been clinically diagnosed without imaging based on presence of abdominal pain and elevated laboratory values; 13 (12.9%) required imaging for diagnosis. Of 88 patients who met AP diagnostic criteria without imaging, 50 (56.8%) nonetheless underwent imaging, with AP without necrosis seen in 34 (68.0%), pancreatic necrosis in one (2.0%), sequelae of prior AP in four (8.0%), and no abnormality in 11 (22.0%).
  
  
  CONCLUSIONS
  Early imaging is common in patients with AP, even when the diagnosis can be established based on non-imaging criteria, rarely demonstrating pancreatic necrosis. Reducing overuse of early imaging in patients with confident diagnosis of AP may improve quality and reduce waste.
authors: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA, ashinagare@partners.org.
authors: Atul B
authors: AB
authors: Shinagare
authors: Ivan K
authors: IK
authors: Ip
authors: Ali S
authors: AS
authors: Raja
authors: V Anik
authors: VA
authors: Sahni
authors: Peter
authors: P
authors: Banks
authors: Ramin
authors: R
authors: Khorasani
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010195:Pancreatitis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D055815:Young Adult