Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 79

The routine use of CT imaging is not warranted as most cases of acute pancreatitis (AP) are mild and uncomplicated [1]. The primary role of imaging during the initial presentation of AP is to ascertain the diagnosis and detect pancreatic and/or extrapancreatic complications [1]. Contrast‐enhanced CT (CECT) is the gold standard for diagnosing AP. It has a sensitivity of 92% [2] and a specificity of up to 100% in detecting AP [3,4].

Contrast‐enhanced multidetector row CT (MDCT) is the gold standard for staging severity, assessing complications, and excluding other conditions that may mimic AP [1,5]. It provides high‐quality, multiphase imaging of the pancreas during a short breath‐hold. It can acquire volumetric information and has two‐ and three‐dimensional forms to deliver complex images. It also has dual phases including arterial and portal phases; intravenous contrast is given at a rate of 3 ml/s during the pancreatic and/or portal venous phase. MDCT has thin collimation and slice thickness [6]. If there is a concern for vascular complications, an additional arterial‐phase scan can be added to the protocol following a rapid intravenous bolus injection or contrast [7]. MDCT with perfusion imaging can be used to detect early pancreatic necrosis through ischemic changes [8]. However, perfusion is not widely available and it is not clear if it carries a true advantage over MDCT imaging. Monophasic contrast‐enhanced CT uses lower doses of radiation compared to dual‐phasic MDCT [7]. It is sufficient in most cases of AP, but one of its limitations is its inability to detect vascular complications.