Role of computed tomography in the evaluation of acute pancreatitis

Purpose: To define accuracy of plain and contrast-enhanced computed tomography in the evaluation of severity of acute pancreatitis and its influence on therapeutic decisions.

Materials and methods: 89 patients with the clinical diagnosis of severe acute pancreatitis were examined by plain and contrast-enhanced helical computed tomography within 24 hours of the onset of symptoms. Clinical and CT scoring of severity were correlated and evaluated from the point of view of their influence on therapeutic strategy.

Results: CT showed severe acute pancreatitis with (hemorrhagic) pancreas necrosis and/or other major organ involvement in 26 patients. Both plain and contrast-enhanced measurements alone were less informative than the combined evaluation, result of which showed good correlation with clinical scoring. Influence of CT findings was essential in prompting decision to operate the patient immediately, while other choices in therapeutic strategy were not basically influenced by CT morphology.

Conclusion: Acute CT examination within the first 24 hours is necessary in those patients only who may be candidates for immediate operation. Both plain and contrast-enhanced measurements are necessary to achieve optimal performance of the modality in this patient group.