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Acute pancreatitis (AP) is a disease associated with sudden onset of abdominal and back pain in a band-like pattern, nausea, and vomiting. In patients with AP, the gold standard, i.e., the initial imaging modality to be used is ultrasonography (US). However, in cases where evaluation is insufficient, computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) are other modalities to be applied. In this study, we aimed to demonstrate the diagnostic accuracy of CT and MRCP in patients with acute pancreatitis.
Seventy-five patients diagnosed with acute pancreatitis were evaluated using CT and, as well as patients who underwent contrast-enhanced MRCP within 48 hours. CT and MRCP were examined in terms of the biliary tract and pancreatic duct structure, gallbladder, common bile duct stones and complications. Chi-square test and the Mann-Whitney U test were used to analyze the data at significance level of p<0.05.
Of all the included patients, 44 were male (58.7%), and the mean age was 59.27 ± 17.37 years. In CT findings, the percentage of AP complication findings such as pancreatic necrosis, extrapancreatic complications, the pancreatic or peripancreatic fluid collection was significantly higher than the MRCP group (p<0.05). MRCP showed biliary tract findings such as cholelithiasis, gallstone, common bile duct dilatation, intrahepatic bile duct dilatation, choledochal stone and pancreatic duct dilatation at a higher percentage than CT.
MRCP was superior to CT in gallbladder and choledochal stone and biliary tract dilatation but not in AP complications. Therefore, non-invasive and radiation-free MRCP can be used more widely in AP patients, especially in emergency departments.
Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology 2018;154:1096-101. DOI: 10.1053/j.gastro.2018.01.032.
Tsuji Y, Takahashi N, Isoda H, et al. Early diagnosis of pancreatic necrosis based on perfusion CT to predict the severity of acute pancreatitis. J Gastroenterol 2017;52:1130-9. doi: 10.1007/s00535-017-1330-5.
Staubli SM., Oertli D, Nebiker CA. Laboratory markers predicting severity of acute pancreatitis. Crit Rev Clin Lab Sci 2015;52:273-83. DOI: 10.3109/10408363.2015.1051659.
Ural Koç, Ýsa Çam. Revised Atlanta classification and roadmap of radiologist Türk Radyoloji Derg 2017;36:46-51. DOI: 10.5152/turkjradiol.2017.532.
Williams E, Beckingham I, El Sayed G, et al. Updated guideline on the management of common bile duct stones (CBDS). Gut 2017;66:765-82. DOI: 10.1136/gutjnl-2016-312317
McGillicuddy EA, Schuster KM, Brown E Maxfield MW, Davis KA, Longo WE. Acute cholecystitis in the elderly: use of computed tomography and correlation with ultrasonography. Am J Surg 2011;202:524-7. DOI: 10.1016/j.amjsurg.2011.06.012.
Mandelia A, Gupta AK, Verma DK, Sharma S. The value of magnetic resonance cholangiopancreato-graphy (MRCP) in the detection of choledocholithiasis. J Clin Diagn Res 2013;7:1941–45. DOI: 10.7860/JCDR/2013/6158.3365.
Grassedonio E, Toia P, Grutta LL, et al. Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis. Gland Surg 2019;8:123-32. doi: 10.21037/gs.2018.12.07.
Sawarkar K, Shaha P, Narayan R, et al. Role of computed tomography in predicting severity of acute pancreatitis and its correlation with clinical outcome. Int J Contemp Med Res 2019;6:10-7. doi:10.21276/ijcmr.2019.6.2.45.
Mir MA, Bali BS, Mir RA, et al. Assessment of the severity of acute pancreatitis by contrast-enhanced computerized tomography in 350 patients. Ulus Travma Acil Cerrahi Derg 2013;19: 103–8. DOI: 10.5505/tjtes.2013.12080.
Zhang J, Li N, Huang B, et al. The Value of Performing Early Non-enhanced CT in Developing Strategies for Treating Acute Gallstone Pancreatitis. J Gastrointest Surg 2016;20: 604–610. doi: 10.1007/s11605-015-3066-y.
Kushwah A, Jain S, Agarwal R, Tomar S. Biliary tract obstructive diseases: a comparative evaluation by ultrasonography and magnetic resonance cholangiopancreaticography (magnetic resonance imaging). Int J Sci Stud 2015; 3:149-53. DOI: 10.17354/ijss/2015/325.
Chen W, Mo JJ, Lin L, Li CQ, Zhang JF. Diagnostic value of magnetic resonance cholangiopancreato-graphy in choledocholithiasis. World J Gastroenterol 2015;21:3351-60. DOI: 10.3748/wjg.v21.i11.3351.
Leppäniemi A, Tolonen M, Tarasconi A, et al. WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg 2019;13:14-27. doi: 10.1186/s13017-019-0247-0.
Roberts SE, Morrison-Rees S, John A, Williams JG, Brown TH, Samuel DG. The incidence and aetiology of acute pancreatitis across Europe. Pancreatology 2017;17:155-65. DOI: 10.1016/j.pan.2017.01.005.
Önmez A, Bilir E, Torun S. The relationship between acute pancreatitis severity of platelet lymphocyte ratio, neutrophil lymphocyte ratio, erythrocyte distribution width and mean platelet volume. Konuralp Med J 2019;11:24-9. DOI: 10.18521/ktd.492274.
Busireddy KK, AlObaidy M, Ramalho M, et al. Pancreatitis-imaging approach. World J Gastrointest Pathophysiol 2014;5:252-70. doi:10.4291/wjgp.v5.i3.252.
Khanna AK, Meher S, Prakash S, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHEII, CTSI Scores, IL-6, CRP, and procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg 2013; Article ID 367581, 10 pages. http://dx.doi.org/10.1155/2013/36758.
Vege SS, DiMagno MJ, Forsmark CE, Martel M, Barkun AN. Initial medical treatment of acute pancreatitis: American Gastroenterological Association Institute technical review. Gastroenterology 2018;154:1103-39. doi: 10.1053/j.gastro.2018.01.031.
Yadav AK, Sharma R, Kandasamy D, et al. Perfusion CT: can it predict the development of pancreatic necrosis in the early stage of severe acute pancreatitis? Abdom Imaging 2015;40: 488-99. doi: 10.1007/s00261-014-0226-6.