title: CT and MRI assessment of symptomatic organized pancreatic fluid collections and pancreatic duct disruption: an interreader variability study using the revised Atlanta classification 2012.
abstract: OBJECTIVE
  Compare CT and MRI for fluid/debris component estimate and pancreatic duct (PD) communication with organized pancreatic fluid collections in acute pancreatitis. Evaluate fat density globules on CT as marker for debris.
  
  
  METHODS
  29 Patients with 46 collections with CECT and MRI performed ≥4 weeks of symptom onset assessed for necrotizing pancreatitis, estimated percentage of fluid volume and PD involvement by two radiologists on separate occasions. T2WI used as standard for estimated percentage of fluid volume. Presence of fat globules and fluid attenuation on CT was recorded. Spearman rank correlation and kappa statistics were used to assess the correlation between imaging techniques and interreader agreement, respectively.
  
  
  RESULTS
  Necrotizing pancreatitis seen on CT in 27 (93%, κ 0.119) vs. 20 (69%, κ 0.748) patients on MRI. CT identified 42 WON and 4 pseudocysts vs. 34 WON, and 12 pseudocysts on MRI. Higher interreader agreement for percentage fluid volume on MRI (κ = 0.55) vs. CT (κ = 0.196). Accuracy of CT in evaluation of percentage fluid volume was 65% using T2WI MRI used as standard. Fat globules identified on CT in 13(65%) out of 20 collections containing <75% fluid vs. 4(15%) out of 26 collections containing >75% fluid (p = 0.0001). PD involvement confidently excluded on CT in 68% collections vs. 93% on MRI.
  
  
  CONCLUSIONS
  MRI demonstrates higher reproducibility for fluid to debris component estimation. Fat globules on CT were frequently seen in organized pancreatic fluid collections with large amount of debris. PD disruption more confidently excluded on MRI. This information may be helpful for pre-procedure planning.
authors.affiliation: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD, 21231, USA, akamal3@jhmi.edu.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Kamal
authors.forename: Vikesh K
authors.initials: VK
authors.lastname: Singh
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Akshintala
authors.forename: Satomi
authors.initials: S
authors.lastname: Kawamoto
authors.forename: Salina
authors.initials: S
authors.lastname: Tsai
authors.forename: Maera
authors.initials: M
authors.lastname: Haider
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
authors.forename: Ihab R
authors.initials: IR
authors.lastname: Kamel
authors.forename: Atif
authors.initials: A
authors.lastname: Zaheer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005122:Exudates and Transudates / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D055815:Young Adult