Comparative assessment of clinical and diagnostic aspects of computed tomographic indices of severity of acute necrotising pancreatitis

Abstract

Objective. To compare the clinical and diagnostic informativeness of computed tomographic indices Balthazar and Mortele (modified) in acute necrotising pancreatitis based on a retrospective assessment of their correlation with the main clinical parameters.
 Materials and methods. The clinical course of acute necrotising pancreatitis and the informativeness of computed tomographic indices were retrospectively compared in 30 patients.
 Results. Moderately severe acute pancreatitis according to the Balthazar index was present in 11 (36.7%) and severe in 19 (63.3%) patients, but according to the Mortele index, moderate severe disease was confirmed in 5 (16.7%) and severe in 25 (83.3%), i.e. in 6 (54.5%) patients, or more than half, the moderate form was retrospectively reclassified as not severe acute pancreatitis. In general, the mean score of the modified index was slightly higher than that of the Balthazar index: 8.4 ± 1.61 and 7.4 ± 1.73, respectively (p<0.05). This is due to the consideration of isolated and combined extrapancreatic lesions in 24 (80%) patients: exudative pleurisy (24), portal vein thrombosis (1). The Mortele index recategorisation of moderate acute pancreatitis according to the Balthazar index led to a decrease in the proportion of patients who underwent ultrasound–guided percutaneous drainage or surgery from 63.6 to 40% (p>0.05). No differences were found in the frequency of surgical treatment of severe acute pancreatitis according to the Balthazar index and the Mortele index – 78.9 and 80%, respectively, and similarly, minimally invasive drainage was ineffective in 44.4 and 36.4% of patients, respectively.
 Conclusions. Both computed tomography indices correlated equally well with the clinical course of severe acute necrotising pancreatitis and the frequency of various surgical treatments.