“PERFUSION CT IN PREDICTING THE DEVELOPMENT OF PANCREATIC NECROSIS IN EARLY STAGE OF SEVERE ACUTE PANCREATITIS”

Abstract

PURPOSE: To evaluate the role of perfusion CT (PCT) scan in predicting the development of pancreatic necrosis (PN) in early stage of severe acute pancreatitis (SAP). MATERIALS AND METHODS: A total of 20 adult patients with a clinical diagnosis of SAP presenting within 72 hours of onset of symptoms with a positive SIRS criteria were included in the study. All the patients underwent PCT on a 128 slice MDCT scannerusing 40 ml of non-ionic iodinated contrast followed by post processing using vendor provided CT perfusion software whereby perfusion parameters were calculated. Perfusion defect (PD) was dened as pancreatic BF and/or BV qualitatively less than hepatic BF and/or BV respectively on the color coded maps. A follow up CECT abdomen was done after 2 weeks as a 'gold standard' to assess whether PN developed in the corresponding region of PD. RESULTS: 8 out of 20 patients developed perfusion defect (PD) on the PCT, of which 6 patients developed PN on the follow up scan. Patients who did not show any PD on the PCT (12 out of 20) did not develop necrosis on the follow up CECT. The sensitivity, specicity, PPV, NPV and accuracy of PCT in predicting necrosis was 100%, 85.71%, 75%, 100% and 90% respectively. The cut off values of pancreatic BF and BV in predicting the development of PN were 34.87 ml/100ml/min and 11.70ml/100ml respectively based on the ROC curve. CONCLUSION: PCT is a useful technique that can predict development of PN in the early stage of SAP so that early aggressive management can be initiated.