Related Experiment Videos
Discordance between CECT and angiographic findings in severe acute pancreatitis-related hemorrhage: implications for
Yinshan Wu1, Jiannan Qian1, Like Qian2
1Department of Critical Care Medicine, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
Insights
Contrast-enhanced computed tomography (CECT) shows limited accuracy in predicting digital subtraction angiography (DSA) findings for severe acute pancreatitis (SAP) bleeding. Negative CECT results require cautious interpretation, prioritizing DSA for definitive diagnosis and treatment guidance.
Area of Science:
- Radiology
- Interventional Radiology
- Gastroenterology
Background:
- Hemorrhagic complications in severe acute pancreatitis (SAP) are life-threatening and necessitate prompt intervention.
- Contrast-enhanced computed tomography (CECT) is standard before digital subtraction angiography (DSA), but its accuracy in predicting DSA findings and treatment success is unclear.
Purpose of the Study:
- To evaluate the intermodality agreement between CECT and DSA in patients with suspected active hemorrhage from SAP.
- To assess the predictive accuracy of CECT findings for angiographic results and clinical outcomes.
Main Methods:
- Retrospective analysis of 69 bleeding episodes in 56 SAP patients who underwent both CECT and DSA.
- CECT and DSA findings were graded; intermodality concordance was assessed using weighted kappa statistics.
- Clinical outcomes including embolization success, rebleeding, and need for surgery were recorded.
Main Results:
- Fair agreement (weighted κ = 0.29) was observed between CECT and DSA.
- Negative CECT (Grade 0) did not preclude successful embolization in 69.2% of cases.
- While CECT Grade 2 had high positive predictive value (94.1%), it correlated with rebleeding and procedural abandonment; 9 patients required surgery.
Conclusions:
- CECT shows limited concordance with DSA findings in SAP patients with suspected hemorrhage.
- Negative or equivocal CECT findings in the presence of persistent clinical suspicion warrant DSA consideration.
- An integrated, clinically driven diagnostic and therapeutic pathway involving DSA is crucial for managing these high-risk patients.
Background:
Hemorrhagic complications in severe acute pancreatitis (SAP) carry high mortality and demand timely intervention. Contrast-enhanced computed tomography (CECT) is routinely performed before digital subtraction angiography (DSA) to guide management decisions, yet its predictive accuracy for angiographic findings and interventional success remains poorly defined.
Materials And Methods:
We conducted a retrospective analysis of 69 bleeding episodes in 56 SAP patients with clinical suspicion of active hemorrhage who underwent both CECT and subsequent DSA. Imaging findings were graded on a 3-point scale (Grade 0: negative; Grade 1: suspicious; Grade 2: definite bleeding). Intermodality concordance was evaluated using weighted kappa statistics, with DSA serving as the reference standard. Clinical outcomes including embolization success, rebleeding, and need for surgical rescue were recorded.
Results:
The intermodality agreement between CECT and DSA was fair (weighted κ = 0.29). Among 26 episodes with negative CECT findings (Grade 0), 69.2% (18/26) required and successfully underwent therapeutic embolization followed by clinical stabilization. Although CECT Grade 2 findings showed a high positive predictive value (94.1%), they were also associated with all instances of rebleeding and procedural abandonment. Nine episodes eventually required surgical rescue after DSA.
Conclusion:
In this selected high-risk cohort of SAP patients undergoing both CECT and DSA for clinically suspected hemorrhagic complications, CECT demonstrated only limited concordance with angiographic findings. Negative or non-definitive CT findings should be interpreted cautiously when clinical suspicion for ongoing hemorrhage persists, and angiographic evaluation should be considered as part of an integrated, clinically driven diagnostic and therapeutic pathway in this high-risk population.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:25Acute Pancreatitis I: Introduction
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include:
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:26Endoscopic Procedures V: ERCP
Patient...
01:21Acute Pancreatitis II: Pathophysiology