Prognostic value of contrast-enhanced computed tomography in acute pancreatitis

Background: Assessment of the severity of acute pancreatitis is important for its proper management. Contrast-enhanced CT has been accepted as useful to assess disease severity and determine its prognosis. The correct differentiation and identification of patients at risk are beneficial for the patient outcome.

Objective: We assessed the prognostic value of contrast-enhanced CT (CECT) in acute pancreatitis and the additional value of necrosis in predicting complication and mortality.

Methods: Two radiologists retrospectively reviewed CECT of 72 patients who were diagnosed with their first episode of acute pancreatitis and were admitted in King Chulalongkorn Memorial Hospital between January 1, 2005 and April 30, 2010. Determination of CECT grade, degree of necrosis and CT severity index were assessed. Data regarding the incidence of complications, the need for surgery or percutaneous intervention, and the number of deaths were collected. Correlation between severity of acute pancreatitis and the patient outcome was analyzed using a χ² test or Student t test.

Results: All complications (n = 14) and deaths (n = 5) occurred in patients with a severe CT grade; however, the differences compared with the mild grade did not reach statistical significance (p = 0.036 and p = 0.58, respectively). Necrosis was identified in 25 patients, all were in the severe grade (p = 0.001). Presence of necrosis in severe CT grade correlates well with occurrence of complications (p = 0.024, OR = 15.0) and mortality (p = 0.046, OR = 8.7). CTSI > 5 correlates well with occurrence of complication (p = 0.024, OR = 17.5) and mortality (p = 0.019, OR = 12.7).

Conclusions: CECT is an effective tool for predicting complication and mortality of acute pancreatitis. Glandular necrosis, which was seen only in patients with a severe CT grade added value in predicting outcomes. Therefore, these results suggest that the use of iodinated contrast material is essential in acute pancreatitis, which is useful for risk stratification, particularly in severe CT disease.