title: Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis.
abstract: Perfusion CT can diagnose pancreatic necrosis in early stage of severe acute pancreatitis, accurately. However, no study to date has examined whether early diagnosis of pancreatic necrosis is useful in predicting persistent organ failure (POF).
  
  
  
  We performed a multi-center prospective observational cohort study to investigate whether perfusion CT can predict the development of POF in the early stage of AP, based on early diagnosis of the development of pancreatic necrosis (PN). From 2009 to 2012, we examined patients showing potential early signs of severe AP (n = 78) on admission. Diagnoses for the development of PN were made prospectively by on-site physicians on the admission based on perfusion CT (diagnosis 1). Blinded retrospective reviews were performed by radiologists A and B, having 8 and 13 years of experience as radiologists (diagnosis 2 and 3), respectively. Positive diagnosis for the development of PN were assumed equivalent to positive predictions for the development of POF. We then calculated the area under the curve (AUC) of the receiver operating characteristic for POF predictions.
  
  
  
  Fourteen (17.9%) and 23 patients (29.5%) developed PN and POF, respectively. For diagnoses 1, 2, and 3, AUCs for POF predictions were 74, 68, and 73, respectively.
  
  
  
  Perfusion CT diagnoses pancreatic necrosis and on that basis predicts the development of POF; http://www.umin.ac.jp/ctr/index-j.htm,UMIN000001926 .
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. ytsuji@kuhp.kyoto-u.ac.jp.|Department of Gastroenterology and Hepatology, The Japan Baptist Hospital, 47 Kitashirakawa Yamanomotocho, Sakyo-ku, Kyoto, 606-8273, Japan. ytsuji@kuhp.kyoto-u.ac.jp.|Shiga University of Medical Science, Seta-Tsukinowacho, Otsu, Shiga, 520-2121, Japan. ytsuji@kuhp.kyoto-u.ac.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA.
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Isoda
authors.affiliation: Division of Clinical Radiology Service, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Koizumi
authors.affiliation: Department of Radiology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Koyasu
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.affiliation: Department of Healthcare Economics and Quality Management, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
authors.affiliation: Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Shujiro
authors.initials: S
authors.lastname: Yazumi
authors.affiliation: Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Asada
authors.affiliation: Digestive Disease Center, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishikawa
authors.affiliation: Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kikuchi
authors.affiliation: Department of Gastroenterology and Hepatology, 1 Chome-1-1 Miwa, Kurashiki, Okayama, 710-0052, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Gastroenterology and Hepatology, Kobe City Medical Center General Hospital, 2-2-1 Minatojima-minami-machi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Inokuma
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsushima
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Esaka
authors.affiliation: Department of Gastroenterology and Hepatology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Okano
authors.affiliation: Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Kawanami
authors.affiliation: Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kakiuchi
authors.affiliation: Department of Gastroenterology and Hepatology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shiokawa
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Kodama
authors.affiliation: Division of Clinical Study of Oncology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Moriyama
authors.affiliation: Department of Radiology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kajitani
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 1060 Nishikawatsucho, Matsue, Shimane, 690-8504, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Pancreatic necrosis; Perfusion CT; Persistent organ failure; Severe acute pancreatitis