Role of multi-detector computed tomography in severity assessment of cases of acute pancreatitis

The mortality and morbidity of acute pancreatitis is high, especially in the severe variant. The present study was performed to study the role of multi-detector computed tomography (MDCT) in grading the severity of acute pancreatitis and to compare the scoring system with the revised Atlanta classification (RAC) and with the outcomes of acute pancreatitis.

A single-centre cross-sectional observational study was conducted between November 2017 and March 2019 with a sample size of 152 patients. Patients underwent a 128-slice contrast-enhanced CT (CECT) of the whole abdomen. Sequential organ failure assessment (SOFA) scores were calculated for all cases. Patients were followed until discharge or death and the outcomes such as hospital stay, intensive care unit (ICU) stay, evidence of organ failure, infection, need for intervention and death were tested with the modified computed tomography severity index (MCTSI) and RAC.

Males constituted the majority of the study population (2.4:1). As per MCTSI, 25 patients (16.5%) had mild pancreatitis, 49 (32.2%) had moderately severe pancreatitis and 78 (51.3%) had severe acute pancreatitis. There was a good concordance between MCTSI and RAC. There was a statistically significant association of MCTSI and RAC with hospital stay, need for ICU stay, organ failure and requirement for intervention; however, there was no statistically significant association with infectious complications and mortality.

The MDCT is a very useful investigation in the diagnosis and management of acute pancreatitis. The threshold to opt for MDCT imaging in acute pancreatitis should be low for performing the timely interventions required in acute pancreatitis.