J Korean Soc Radiol.  2020 Nov;81(6):1436-1447. 10.3348/jksr.2020.0012.

Prediction of Necrotizing Pancreatitis on Early CT Based on the Revised Atlanta Classification

• Song YS
• Park HS
• Yu MH
• Kim YJ
• Jung SI

• KMID: 2509105
• DOI: http://doi.org/10.3348/jksr.2020.0012

Abstract

Purpose
To investigate the clinical and CT features at admission to predict the progression to necrotizing pancreatitis (NP) in patients initially diagnosed with interstitial edematous pancreatitis (IEP).
Materials and Methods
Patients with IEP who underwent contrast-enhanced CT at admission and follow-up CT (< 14 days) were included (n = 178). Two radiologists performed a consensus review of follow-up CT scans and diagnosed the type of acute pancreatitis as IEP or NP. Laboratory findings at admission were recorded. Clinical, CT, and laboratory findings were compared between the IEP-IEP group and IEP-NP group using the chi-square test and the t-test. Multivariate analysis was also performed.
Results
There were 112 and 66 patients in the IEP-IEP and the IEP-NP groups, respectively. The proportion of patients with alcohol etiology was significantly larger in the IEP-NP group. Among the CT findings, the presence of peripancreatic fluid and heterogeneous parenchymal enhancement were more frequently observed in the IEP-NP group. Among the laboratory variables, serum C-reactive protein levels and white blood cell counts were significantly higher in the IEP-NP group. Multivariate analysis revealed that the presence of peripancreatic fluid and heterogeneous parenchymal enhancement were significant findings distinguishing the two groups.
Conclusion
CT findings, such as the presence of peripancreatic fluid and heterogeneous pancreatic parenchymal enhancement, may be helpful in predicting the progression to NP in patients initially diagnosed with IEP.

Keyword

Acute Pancreatitis; Acute Edematous Pancreatitis; Acute Necrotizing Pancreatitis; Pancreatic Necrosis; Peripancreatic Fat Necrosis; Computed Tomography; X-Ray