Gastroenterology

Gastroenterology

Volume 126, Issue 3, March 2004, Pages 715-723
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis

https://doi.org/10.1053/j.gastro.2003.12.006Get rights and content

Abstract

Background & Aims: This study aimed to compare the accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing acute pancreatitis (AP) and to explore the correlation between MRI findings and clinical outcome. Methods: Patients with AP were investigated by contrast-enhanced CT and MRI on admission and 7 and 30 days thereafter. MRI was performed with intravenous secretin and contrast medium. Balthazar’s grading system was used to measure CT and MRI severity indices (CTSI and MRSI, respectively). Results: Thirty-nine patients (median age, 47 years; range, 15–86) were studied. AP was of biliary etiology in 19 patients (49%). On admission, AP was assessed clinically as severe in 7 patients (18%). A strong correlation was demonstrated between CTSI and MRSI on admission and 7 days later. MRSI on admission correlated with the following: the Ranson score, C-reactive protein levels 48 hours after admission, duration of hospitalization, and clinical outcome regarding morbidity, including local and systemic complications. Considering the Ranson score as the gold standard, MRI detected severe AP with 83% (58–96, 95% CI) sensitivity, 91% (68–98) specificity vs. 78% (52–93) and 86% (63–96) for CT. Magnetic resonance cholangiopancreatography after IV secretin injection showed pancreatic duct leakage in 3 patients (8%). Conclusions: MRI is a reliable method of staging AP severity, has predictive value for the prognosis of the disease, and has fewer contraindications than CT. It can also detect pancreatic duct disruption, which may occur early in the course of AP.

Section snippets

Patients

Patients with AP admitted to our institution during the period between January 2001 and September 2002 were considered for inclusion in this prospective study. Diagnosis of AP was based on the presence of typical abdominal pain combined with a 3-fold elevation of serum levels of amylase and lipase. AP was considered of biliary origin if there was a 2-fold elevation of transaminases combined with the presence of stones in the gallbladder.18 It was considered of alcoholic etiology if it had been

Clinical and laboratory findings

Thirty-nine patients (23 men and 16 women) were included in the study (median age, 47 years; range, 15–86). The median interval between the onset of symptoms and admission was 22 hours (2–48). All patients had a 3-fold elevation of serum amylase and lipase levels. Median serum amylase and lipase values on admission were 643 IU (185–8656) and 1517 IU (141–13,943), respectively (upper normal values were 125 IU and 75 IU for amylase and lipase, respectively). AP was biliary in 19 patients (49%)

Discussion

The present results show that MRI is a reliable alternative to contrast-enhanced CT for assessing the severity of AP and predicting its outcome. MRI indeed allowed evaluation of the spread of pancreatic and extrapancreatic acute fluid collections, as well as the extent of necrosis. The major advantages of MRI are that it can be proposed to nearly all patients without clinical limitations and its accurate visualization of pancreatic and biliary ducts permits the detection of pancreatic duct

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