CT severity of post-ERCP pancreatitis: results from a single tertiary medical center.

PURPOSE: To evaluate the CT severity of post-ERCP pancreatitis (PEP) and determine the association between radiographic and clinical severity. METHODS: There were 1332 patients admitted to the hospital with suspicion for PEP after undergoing ERCP as outpatients over a 10-year period, of whom 84 (6.3%) patients underwent at least one contrast-enhanced CT scan while hospitalized were evaluated. All CT scans were evaluated by two radiologists, and the modified CT severity index (MCTSI) score was calculated. Demographic, clinical, and procedural data as well as clinical severity parameters including systemic inflammatory response syndrome, organ failure, need for ICU, need for intervention, length of hospital stay, and mortality were recorded. Statistical analysis was performed using the χ (2) and Student's t test or ANOVA and logistic regression analysis. RESULTS: Patients were predominantly females (70%) with a mean age of 46.5 years (range 20-86). The most common indication for ERCP was sphincter of Oddi dysfunction. MCTSI was graded as mild in 45 (53.6%), moderate in 36 (42.8%), and severe in 3 (3.6%) patients. The interobserver agreement was excellent (κ: 0.91, p < 0.0001) for MCTSI. The duration of ERCP (p = 0.005) was the only risk factor for PEP that significantly correlated with the MCTSI score. Increasing MCTSI was significantly associated with hospital length of stay. CONCLUSIONS: PEP is typically a mild disease by radiologic and clinical criteria. Longer duration of ERCP is a risk factor for severe radiologic PEP. Severe radiographic PEP is associated with significantly longer hospital length of stay.

Using Multidetector CT in Predicting Resectability of Pancreatic Head Tumors: Surgical and Pathologic Correlation.

BACKGROUND: Computed tomography (CT) is widely used to pre-operatively evaluate patients with pancreatic tumors. AIM: The purpose of this study is to evaluate retrospectively, the ability of multi-detector computed tomography (MDCT) to predict resectability of pancreatic cancer on the basis of surgical outcome and pathologic correlation. PATIENTS AND METHODS: Sixty nine consecutive patients presenting between January 2007 and June 2010 with pancreatic head tumors were included in the study. The study group comprised patients with pancreatic head tumors from the local catchment area and others referred to our tertiary care center from surrounding hospitals. Sixty nine examinations were performed with the same 64 slice CT scan (Brillinat Philips). All patients were imaged using a standardized MDCT protocol. Patients with disease that was clearly inoperable were excluded from the study. The remaining patients (32) had their CT studies double-reported using a standard method. Images were scored for vascular involvement, tumor size and the presence of distant metastases. Surgical and pathologic reports were reviewed and compared to CT results. Frequencies, mean and range were used as descriptive statistics, positive predictive value (PPV) and negative predictive value (NPV) and sensitivity, specificity and accuracy were done using SPSS version 18 program. RESULTS: Of the 32 patients evaluated, 65.6% had successful resection of pancreatic head tumors; while 34.4% had a palliative procedure. When compared to surgical outcome, the positive predictive value of multidetector computed tomography for resectability was 100%. On the basis of pathologic results (considering the surgical technique and the positive surgical margin as a microscopic picture), the negative predictive value of multi-detector computed tomography for resectability fell to 65.5%, Three patients deemed resectable following multi-detector computed tomography had positive margins at pathology. CONCLUSION: There is improved prediction of resectability ÷ unresectability with the introduction of MDCT. When compared to Helical computed tomography (HCT) studies, there is a rise in the rate of successful surgical resection with a concomitant decrease in the rate of palliative surgery. The positive predictive value of multidetector computed tomography for resectable disease is lower when pathologic correlation, as opposed to surgical correlation, is used as the gold standard. KEY WORDS: Multidetector computed tomography (MDCT)- Resectability÷unresectability prediction- Pancreatic head tumors.