Prospective Evaluation of Acute Pancreatitis in Early Diagnosis Using Modified CT Severity Index

Abstract

Introduction: Acute pancreatitis is a disease with high rate of morbidity and mortality and is known to run an unpredictable course. CT is the standard non invasive investigation to evaluate pancreatic parenchymal changes, peri pancreatic changes and complications associated with pancreatitis. Aim: To determine the value of CT evaluation in early diagnosis of acute pancreatitis and use as baseline imaging modality. To use modified CT severity grading system to grade the severity of acute pancreatitis. Materials and Methods: This is a prospective study conducted from January 2013 to June 2014. The study was approved by institutional review board. Patients with clinically suspected/diagnosed acute pancreatitis, altered serum amylase, serum lipase and ultrasound diagnosed cases of acute pancreatitis were included in the study. The study was conducted using GE16 slice CT scanner standard protocol, oral and IV contrast were used. Descriptive statistics (Tabulations, graphs and charts, proportions, percentage) are used. Results: About 60 patients were included in our study. Oedematous pancreatitis was in 28% patients and pancreatic necrosis was in 25% patients. Features like diffuse/focal pancreatic enlargement in 76%, peri pancreatic fat stranding in 63% and peri pancreatic fluid collection in 33%. Modified CT severity index was classified as mild, moderate and severe of which majority were mild (65%). The accuracy and sensitivity of serum amylase and serum lipase in diagnosing AP were 45% and 65%. Conclusion: CT is a sensitive, non invasive imaging in early diagnosis and staging of severity of acute pancreatitis which help in prediction of prognosis of the disease. It helps to initiate the treatment at earliest in rural areas. It also helps to differentiate between oedematous and necrotising pancreatitis, as serum lipase and amylase levels do not help to differentiate the type of AP. Modified CT severity index helps in evaluating the percentage pancreatic necrosis and to predict the possibility of developing local and systemic complications and necessity of tertiary care.

Keywords

• necrosis
• pancreatic necrosis
• sevirty