title: Perfusion CT: can it predict the development of pancreatic necrosis in early stage of severe acute pancreatitis?
abstract: OBJECTIVE
  Pancreatic necrosis is an important determinant of patient outcome in severe acute pancreatitis (SAP). This prospective study was conducted to evaluate if perfusion CT (PCT) can predict the development of necrosis at an early stage in SAP.
  
  
  METHODS
  PCT was performed within 72 h of abdominal pain in 57 consecutive admitted patients of acute pancreatitis, out of which four patients were excluded. Thirty-two patients were classified as SAP and 21 as mild acute pancreatitis (MAP) on the basis of APACHE II or SIRS criteria or presence of organ failure. All patients underwent a follow-up CECT at 3 weeks to look for pancreatic necrosis.
  
  
  RESULTS
  Out of 32 patients of SAP, 14 patients showed perfusion defects. The mean blood flow (BF) in these areas was 11.47 ± 5.56 mL/100 mL/min and median blood volume (BV) was 3.92 mL/100 mL (0.5-8.49 mL/100 mL). All these patients developed necrosis on follow-up scan. Two patients who did not show perfusion defects also developed necrosis. Remaining 37 patients (16 SAP and 21 MAP) did not show perfusion defect and did not develop necrosis on follow-up. All regions showing BF less than ≤23.45 mL/100 mL/min and BV ≤8.49 mL/100 mL developed pancreatic necrosis. The values of perfusion parameters may vary with the scanner, mathematical model and protocol used. The sensitivity and specificity of PCT for predicting pancreatic necrosis were 87.5% and 100%, respectively. The cut off values of BF and BV for predicting the development of pancreatic necrosis were 27.29 mL/100 mL/min and 8.96 mL/100 mL, respectively, based on ROC curve. PCT is a reliable tool for early prediction of pancreatic necrosis, which may open new avenues to prevent this ominous complication.
authors.affiliation: Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India, ajayyadav_01@hotmail.com.
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Yadav
authors.forename: Raju
authors.initials: R
authors.lastname: Sharma
authors.forename: Devasenathipathy
authors.initials: D
authors.lastname: Kandasamy
authors.forename: Ashu Seith
authors.initials: AS
authors.lastname: Bhalla
authors.forename: Shivanand
authors.initials: S
authors.lastname: Gamanagatti
authors.forename: Deep N
authors.initials: DN
authors.lastname: Srivastava
authors.forename: Ashish Datt
authors.initials: AD
authors.lastname: Upadhyay
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Garg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000098:blood supply / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult