Читать книгу Clinical Pancreatology for Practising Gastroenterologists and Surgeons - Группа авторов - Страница 87

CT imaging is associated with multiple risks. While the use of intravenous contrast in assessing the complications and severity of AP is of great value, it is also associated with side effects. Acute reactions associated with the injection of contrast may be minor, intermediate, or severe. Minor reactions include flushing, mild urticaria, nausea, headache, and vomiting. These reactions are self‐limited. Intermediate reactions may involve bronchospasm and hypotension which will respond to therapy. Severe reactions may include laryngeal edema, convulsions, loss of consciousness, cardiac dysrhythmia and/or arrest, and pulmonary edema [54].

Another risk is contrast‐induced induced nephrotoxicity (CIN). CIN is defined by an absolute rise of more than 0.5 mg/dl or 25% in serum creatinine within 48–72 hours of iodinated contrast [55]. However, recent studies have shown that the risk of CIN following contrast is far lower than previously reported, particularly in patients with normal renal function [56]. Nonetheless, patients with a glomerular filtration rate below 30 ml/min, preexisting renal insufficiency (creatinine >1.5 mg/dl), diabetes mellitus, sepsis, and diuretic use have as high as 25% risk of developing CIN [57] and established preventive measures such as fluid hydration may still be recommended [55].

A commonly overlooked risk of CT imaging is ionizing radiation exposure. which can damage cellular DNA and increase the risk of cancer. Approximately 2% of all cancer diagnoses in the United States are a result of ionizing radiation exposure during CT scans imaging, which is likely attributable to the 600‐fold increase in radiation exposure from CT imaging over the past 20 years [58]. Abdominopelvic CT delivers 100 times as much ionizing radiation as conventional radiographic imaging. The mean radiation dose in patients with ANP and severe AP is 31–40 mSv [59,60]. The mean number of abdominal CT scans per patient with AP was reported to be 1.9 (range 1–12) per hospitalization [59]. Those with severe AP undergo a higher number of CT imaging studies during hospitalization and, therefore, receive higher doses of radiation [61].

CT imaging should only be pursued when the results will impact patient management as this will also help reduce unnecessary exposure to ionizing radiation.