Usefulness of early ultrasound and CT examinations in assessing acute pancreatitis severiy
Aim: To compare the usefulness of early ultrasound (US) and CT in assessing acute pancreatitis (AP) severity and to evaluate the correltions with clinical outcome.
Methods: We studied a group of 116 patients with AP (68–41,38% men and 48–41,38% women, mean age 54,1+14,74 years old), admitted in the Gastroenterology Department Timisoara. All patients were classified according to Ranson score and Atlanta Criteria and underwent US and CT evaluation (according to Balthasar score-CT Severity Index, CTSI).
Results: Mean Ranson score was 2,51 (in mild AP:1,28, moderate:3,41, severe 6,75). Mean CTSI was 3 (in mild forms 1,8 moderate 3, severe 6,5). 19%(22) patients had systemic complications meeting the Atlanta criteria. Overall, US modifications occurred in 38 patients (32,75%) versus 54 (46,55%) at CT. Necrosis was detectable at US only in 8,62% (10)cases versus 22,41% cases at CT (p=0,040219-S), in the remaining cases US was not able to discriminate between parenchyma oedema and necrosis. Fluid collections were present in 33,25% (38) cases at US and in 40,55% (47) cases at CT. Regarding other US aspects, such as peripancreatic fat involvement (that occurred in 15,79% cases at US and in 28,56% at CT), peripancreatic cysts (15,51% casers at US and 21,55% at CT), none showed any correlation wit CT (p=0,74881-NS, p=0,672660-NS respectively).
Conclusions: Early evaluation in patients with AP by US is useful in the diagnosis of necrosis and fluid collections.Regarding correlations between US and clinical variables and outcome, a strong correlation was observed between US and Ranson score (p<0,05) and US and C reactive protein (p<0,001).