Role of Imaging Methods in Diagnosis of Acute Pancreatitis

Abstract

Diagnosis and treatment of acute pancreatitis is a complex interdisciplinary team problem. Without knowledge of classification and the current opinion of other experts on this disease, the radiologist cannot be an adequate partner in this team. Nonetheless, the radiologist has a very important position, primarily ‘thanks to’ computed tomography (CT) in diagnosis and fading of the disease and the possibilities offered by minimally invasive treatment of early and late complications of this disease. A turning point from the viewpoint of diagnosing acute pancreatitis was first marked by Balthazar’s classification and then establishing the CTSI (severity index for the disease based on CT findings), proposed by Balthazar as well. Radiologists’ increasingly more active approach to drainage of acute fluid collections and pseudocysts in patients with acute pancreatitis as well as some possibilities for percutaneous treatment of necroses has led to a reassessment of surgeons’ attitudes. A persistent problem is the correct indication and timing of CT scans and the drainage itself. In their concise communication, the authors present data from the literature and summarize their own experience. They highlight the most common mistakes, especially in the indication and timing of individual methods. Finally, they present their views on a practical approach to the use of CT and percutaneous drainage in these patients.

The revised Atlanta classification for acute pancreatitis: a CT imaging guide for radiologists

“…3). In equivocal cases, ultrasound or CT-guided fine needle aspiration can be performed to definitely evaluate the presence of infection [12].…”

“…In the case of acute, sterile, peripancreatic fluid collections, treatment is conservative as most of these collections will usually resolve over 2 to 4 weeks. Infected collections require drainage and a diagnostic puncture can be performed if the clinical or imaging findings for infection are equivocal [12].…”