The radiologic assessment of acute pancreatitis and its complications

This review summarizes the role of radiologic tests, especially CT, in the diagnosis and assessment of acute pancreatitis and its complications. Consideration of the underlying pathologic changes of complicated pancreatitis and their radiographic correlates allows identification of the presence, extent, and nature of local complications. This information can be crucial in making appropriate management decisions. Based on these data, general guidelines for the appropriate use of CT in acute pancreatitis can be formulated. Patients with clinically mild pancreatitis in whom the diagnosis is secure probably do not require imaging as long as they respond appropriately to conservative management. In patients with clinically severe pancreatitis, early CT should be performed to evaluate the extent and nature of local complications. If radiographic changes are mild and the patient responds to conservative management, no further imaging is needed. If the patient does not respond appropriately or clinically worsens, follow-up CT should be performed, seeking delayed complications. Patients in whom the initial CT shows severe pancreatitis and peripancreatic inflammatory changes should be followed with serial CT to assess resolution. Initially, serial CT should be performed every 1-2 weeks, or sooner if clinically indicated. If at any time there is clinical suspicion of infection, aggressive use of FNA is indicated. The decision to intervene, whether for infectious or sterile complications of pancreatitis, must still be made on clinical grounds. CT can be helpful in choosing the appropriate means of intervention.