MDCT Manifestations of ANP: Relationship Between Pancreatic Glandular Necrosis and Retroperitoneal Spreading and Clinical Disease Severity_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHENG Yan ¹ , SONG Bin ¹ , XU Jun ² , MIN Pengqiu ¹ , LIU Jie ¹ , WU Bi. ¹

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Acute necrotizing pancreatitis Multi-detector-row spiral CT Clinical severity

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【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP.
MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing.
Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance.
ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.

Citation： CHENG Yan,SONG Bin,XU Jun,MIN Pengqiu,LIU Jie,WU Bi.. MDCT Manifestations of ANP: Relationship Between Pancreatic Glandular Necrosis and Retroperitoneal Spreading and Clinical Disease Severity. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2006, 13(1): 110-115. doi: Copy

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1. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation [Ｊ]. Radiology， 2002; 223(3)∶603.
2. Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis [Ｊ]. Radiology， 1990; 174(2)∶331.
3. Ranson JH, Rifkind KM, Roses DF, et al. Objective early identification of severe acute pancreatitis [Ｊ]. Am J Gastroenterol， 1974; 61(6)∶443.
4. Fishman EK. From the RSNA refresher courses: CT angiography: clinical applications in the abdomen [Ｊ]. Radiographics， 2001; 21 Spec No∶S3.
5. Schoenhagen P, Halliburton SS, Stillman AE, et al. Noninvasive imaging of coronary arteries: current and future role of multidetector row CT [Ｊ]. Radiology, 2004; 232(1)∶7.
6. Rydberg J, Buckwalter KA, Caldemeyer KS, et al. Multisection CT: scanning techniques and clinical applications [Ｊ]. Radiographics, 2000; 20(6)∶1787.
7. Cohnen M, Poll L, Puttmann C, et al. Radiation exposure in multislice CT of the heart [Ｊ]. Rofo, 2001; 173(4)∶295.
8. Fuchs T, Kachelriess M, Kalender WA. Technical advances in multislice spiral CT [Ｊ]. Eur J Radiol, 2000; 36(2)∶69.
9. Balthazar EJ, Freeny PC, van Sonnenberg E. Imaging and intervention in acute pancreatitis [Ｊ]. Radiology, 1994; 193(2)∶297.
10. Sakorafas GH, Tsiotos GG, Bower TC, et al. Ischemic necrotizing pancreatitis. Two case reports and review of the literature [Ｊ]. Int J Pancreatol, 1998; 24(2)∶117.
11. Johnson CD, Stephens DH, Sarr MG. CT of acute pancreatitis: correlation between lack of contrast enhancement and pancreatic necrosis [Ｊ]. AJR Am J Roentgenol， 1991; 156(1)∶93.
12. 宋彬，徐隽. 急性胰腺炎的CT评价 [Ｊ]. 中国普外基础与临床杂志， 2003; 10(6)∶623.
13. Banks PA. Acute pancreatitis: medical and surgical management [Ｊ]. Am J Gastroenterol, 1994; 89(8 suppl)∶S78.
14. Banks PA. Practice guideline in acute pancreatitis [Ｊ]. Am J Gastroenterol, 1997; 92(3)∶377.
15. Blamey SL, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis [Ｊ]. Gut, 1984; 25(12)∶1340.
16. Agarwal N, Pitchumoni CS. Simplified prognostic criteria in acute pancreatitis [Ｊ]. Pancreas, 1986; 1(1)∶69.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDCT Manifestations of ANP: Relationship Between Pancreatic Glandular Necrosis and Retroperitoneal Spreading and Clinical Disease Severity

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