Incorrect estimation of severity of acute pancreatitis by contrast-enhanced computed tomography
Sainio, V.S.; Puolakkainen, P.A.; Kemppainen, E.J.; Kivisaari, L.; Haapiainen, R.K.; Schröder, T.M.; Lehtonen, E.I.; Kivilaakso, E.O.
Annales Chirurgiae et Gynaecologiae 86(3): 214-221
1997
ISSN/ISBN: 0355-9521 PMID: 9435932 Document Number: 469997
Background and Aims: In acute pancreatitis, contrast-enhanced CT is widely accepted to give reliable Information in the early assessment of severity. This study critically evaluates the clinical data, outcome, and CE-CT findings in patients with incorrect radiological estimation of the severity of the condition. Material and Methods: All patients suspected of having severe pancreatitis underwent contrast-enhanced CT. Clinical data and CE-CT findings of 341 patients were re-examined. Results and Conclusions: In 28 patients (8.2%) the radiological diagnosis was inconsistent with the clinical findings. The most common reason - in 20 of the 28 patients (71.4%) - for failure to estimate the severity of pancreatitis was partial necrosis of the gland. In severe cases the partial necrosis was overlooked in nine patients (32.1%). In mild cases clinical significance of partial necrosis - overestimated as representative for the whole gland and technical failure both explained the incorrect interpretation in six (21.4%) patients; and in five patients (17.9%) intermediate patchy enhancement was incorrectly regarded as low. The misleading estimation remained inexplicable in only two (7.1%) patients. These results emphasize adequate assessment of CE-CT and inclusion of all areas of the pancreas in the estimation of enhancement.