Can contrast-enhanced ultrasound evaluate the severity of acute pancreatitis?

To investigate the ability of contrast-enhanced ultrasound (CEUS) in the assessment of acute pancreatitis (AP), as well as its diagnostic accuracy in the evaluation of the severity of pancreatitis.

A prospective double-blind study was carried out in 33 AP patients from May 2007 to January 2008. Each patient underwent both CEUS and contrast-enhanced computed tomography (CECT) with the time interval between two examinations less than 72 h. Using CECT as gold standard, the ability of CEUS to diagnose pancreatic necrosis as well as peripancreatic effusion and/or complications, and its diagnostic value in the evaluation of the severity of pancreatitis, were investigated. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI), and the correlation between CTSI and USSI was tested by Spearman's rank correlation coefficient.

A strong correlation between CTSI and USSI was found (r = 0.92, P < 0.01).The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS in the diagnosis of pancreatic parenchyma necrosis were 90, 95, 94, 90 and 95%, in the diagnosis of peripancreatic effusion and/or complications were 83, 100, 93, 100 and 91%, and in the diagnosis of severe pancreatitis were 97, 67, 94, 97 and 67%, respectively.

CEUS has shown to be of clinical value in the assessment of pancreatic necrosis as well as peripancreatic complications in AP and has a high diagnostic accuracy in the evaluation of the severity of pancreatitis. Further studies are needed to add it to the diagnostic algorithm for acute pancreatitis.