Comparison of contrast-enhanced CT with diffusion -weighted MRI in the Evaluation of patients with acute biliary pancreatitis
Mehmet İlhan1, Muhammet Üçüncü2, Ali Fuat Kaan Gök1, Gizem Öner1, Elidor Agolli3, Bahar Canbay1, Barış Bakır3, Recep Güloğlu1, Cemalettin Ertekin1
1Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
2Clinic of General Surgery, Arnavutköy State Hospital, İstanbul, Turkey
3Department of Radiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
Keywords: DWI MR, pancreatitis severity, pancreatitis, contrast enhanced computerized tomography
Objective: The aim of this study was to compare contrast-enhanced computed tomography with diffusion-weighted magnetic resonance imaging in the evaluation of patients with acute biliary pancreatitis.
Material and Methods: Fifty-three patients diagnosed with acute biliary pancreatitis, between February 2012 and July 2015, were evaluated using diffusion-weighted magnetic resonance imaging and magnetic resonance cholangiopancreatography to explain the elevation of cholestasis enzymes and bilirubin levels at İstanbul University. Contrast-enhanced computed tomography imaging was applied within 8 h following first evaluation. Demographic data, severity of pancreatitis, pancreatic apparent diffusion coefficient, and computed tomography severity index were compared. The significance of the results was evaluated using Statistical Package for the Social Sciences 21.0 program.
Results: Median age was 53.39 (22-90) years in these 53 patients (26 were males and 27 were females). The mean Ranson criterion was 0.96 (0-4) and mean hospitalization duration was 16.02 (3-100) days. Twenty-eight patients were evaluated to have mild acute pancreatitis, whereas 16 were moderately severe and nine were severe based on the Revised Atlanta Classification. Mild pancreatitis score was 0.89, moderately severe pancreatitis score was 3.50, and severe pancreatitis score was 5.78 using the Balthazar score. Elevated C-reactive protein levels were not correlated with necrosis and the clinical severity score (p>0.05). There was no significant difference among the Balthazar score, magnetic resonance cholangiopancreatography-apparent diffusion coefficient score, and Revised Atlanta score in the evaluation of the severity of pancreatitis when the two techniques were compared. A statistically insignificant difference was found between the Balthazar score and magnetic resonance imaging results of clinically confirmed necrosis and non-necrosis patients.
Conclusion: It can be concluded that diffusion-weighted magnetic resonance imaging might be better than contrast-enhanced computed tomography in the diagnosis of acute pancreatitis as it avoids radiation exposure as well as the development of renal failure and pancreatitis aggravation due to the use of contrast for computed tomography. These results need to be confirmed with randomized prospective controlled studies.
Cite this paper as: İlhan M, Üçüncü M, Gök AFK, Öner Ö, Agolli E, Canbay C, Bakır B, Güloğlu R, Ertekin C. Comparison of contrast-enhanced CT with diffusion -weighted MRI in the Evaluation of patients with acute biliary pancreatitis. Turk J Surg 2017; 33: 153-157.
Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects” (amended in October 2013).
Written informed consent was obtained from patients who participated in this study.
Concept - M.İ, M.Ü., G.Ö.; Design - M.İ., G.Ö.; Supervision - C.E., E.A., R.G.; Resource - M.Ü., A.F.K.G.; Materials - G.Ö., E.A.; Data Collection and/or Processing - E.A., B.C.; Analysis and/or Interpretation - M. İ., M.Ü., A.F.K.G.; Literature Search - G.Ö., B.B.; Writing Manuscript - M.İ, M.Ü., G.Ö.; Critical Reviews - B.B., R.G., C.E.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.