title: Perfusion-CT--Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?
abstract: OBJECTIVE
  Severe acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.
  
  
  METHODS
  79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4-6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.
  
  
  RESULTS
  Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.
  
  
  CONCLUSIONS
  CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.
authors.affiliation: II Department of Radiology-Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pieńkowska
authors.affiliation: I Department of Radiology-Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Gwoździewicz
authors.affiliation: I Department of Radiology-Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Skrobisz-Balandowska
authors.affiliation: Department of Gastroenterology and Hepatology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Marek
authors.affiliation: Department of General Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Kostro
authors.affiliation: II Department of Radiology-Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Szurowska
authors.affiliation: I Department of Radiology-Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.|Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Studniarek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply* / Q000473:pathology; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D055420:Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D008049:Lipase; D000681:Amylases