COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF ACUTE PANCREATITIS AND
ITS COMPLICATIONS
Lukashev A.D.1, Kurochkin S.V.2, Malkov I.S.3, Bakhtiozin R.F.4, Ahmetzyanova L.R.1
1 - Kazan (Volga Region) Federal University. Kazan, Russia.
2 - M.N. Sadykov City Clinical Hospital No. 7. Kazan, Russia.
3 - KGMA, RMANPO. Kazan, Russia.
4 - Sechenov University. Moscow, Russia.
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espite the accumulated experience and high diagnostic capabilities of radiological imaging methods, the issue of early and proper diagnosis of acute pancreatitis with further prediction of severity to selection of adequate therapeutic tactics.
Purpose. To evaluate the possibilities of computed tomography in improving diagnostic criteria of the prevalence and severity of acute pancreatitis (AP).
Material and methods. The data of medical records of 923 patients with referral diagnosis – acute pancreatitis (ICD-10 code: K85.0, K85.1, K85.2, K85.8, K85.9) were analyzed, of which 472 were diagnosed with acute pancreatitis, 88 patients who were hospitalized at the M.N. Sadykov City Clinical Hospital No. 7 from 01.01.2023 to 01.01.2024 with a confirmed diagnosis of acute pancreatitis were included in the present study. All patients were examined using the intravenous-contrast enhanced computed tomography (CT) scan of abdomen at different hospitalization durations, CT scans being performed not earlier than after 72 hours upon the onset of the clinical pattern of acute pancreatitis.
Entry criteria:
1. Patients with the proven diagnosis of acute pancreatitis (ICD-10 codes: K85.0, K85.1, K85.2, K85.8, and K85.9);
2. Clinical pattern of acute pancreatitis;
3. Amylase or lipase levels triply exceeding the upper values of their respective normal ranges; 4. Scans obtained using contrast-enhanced computed tomography of abdomen and demonstrating the CT signs of acute pancreatitis.
Exclusion criteria:
1. Unenhanced CT scan of abdomen;
2. Pancreatic tumors;
3. No CT signs of acute pancreatitis.
Afterwards, computed tomography images were analyzed with a CT-based acute pancreatitis severity score (CT APSS) being formed, followed by the stratification of patients by their acute pancreatitis severity levels.
The following acute pancreatitis severity indexes were used as reference procedures:
1. CT severity index (CTSI);
2. Modified CT severity index (MCTSI).
The work was performed in several steps. Step 1 – assessment of AP prevalence with allocation of areas of abdominal cavity and retroperitoneal lesions with ranking by points; step 2 – assessment of pancreatic and extrapancreatic complications with indication of letter symbols; step 3 – determination of AP severity, summarizing the results of assessment of prevalence and complications with formation of acute pancreatitis severity rating scale (SAS-CT).
Results and discussion. Based on the findings of our study, the patients' mean age was 51.99 ± 14.36 years, which coincides with the findings obtained by Khan et al., middle-aged patients (31-40 years old) prevailing among them; similar findings were demonstrated in the studies of Melkundi, S. S. et al. Number of patients with severe acute pancreatitis, when using MCTSI and SAS-CT, predominates over classical CTSI, mild cases prevailing in CTSI rather than elsewhere. This is probably due to no evaluation of extrapancreatic complications, which is confirmed in the study of Sahu et al. According to SAS-CT, the area score is a statistically significant predictor of necrotizing pancreatitis (AUC = 0.705; 95% CI: 0.593 – 0.818, p <0.001). When analyzing the index of length of hospital stay according to the severity of AP with CTSI, MCTSI and SAS-CT, a statistically significant correlation was found for all severity groups: p = 0.006 for CTSI and p < 0.001 for MCTSI and SAS-CT.
Conclusion. In our study, we defined the key criteria of optimal and efficient acute pancreatitis severity score based on computed tomography scan, such as acute pancreatitis prevalence and acute pancreatitis complications. Based on the above criteria, a CT-based acute pancreatitis severity score (SAS-CT) was formed and its potential was determined as a tool for predicting and evaluating the disease severity in patients with acute pancreatitis.
Keywords: computed tomography scan, acute pancreatitis, necrotizing pancreatitis, complications.
Corresponding author: Kurochkin S.V. e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Lukashev A.D., Kurochkin S.V., Malkov I.S., Bakhtiozin R.F., Ahmetzyanova L.R. Computed tomography in the diagnosis of acute pancreatitis and its complications. REJR 2025; 15(4):100-118. DOI: 10.21569/2222-7415-2025-15-4-100-118.
Received: 04.07.25 Accepted: 18.12.25