Imaging modalities for necrotizing pancreatitis: what’s new (literature review)

Pancreatic necrosis is the most severe form of acute pancreatitis; which is accompanied by a high risk of developing serious complications such as sepsis; peritonitis; multiple organ failure; etc. The mortality rate of pancreatic necrosis reaches 60–80 %; according to many authors; representing a huge problem of emergency abdominal surgery. Pancreatic necrosis most often develops in young and middle-aged people; which makes it an important social problem. Despite recent advances in pancreatology; improvement of diagnostic methods; and the emergence of new treatment methods; difficulties in choosing the optimal treatment and diagnostic tactics for pancreatic necrosis remain. In this review article; we analyzed new studies presented in open sources devoted to the diagnosis and treatment of acute pancreatitis. The search for scientific publications was conducted in the electronic database of the Scientific Library of Russia (eLibrary.ru) and the US National Library of Medicine (PubMed.org) in Russian and English. The following keywords were used as search queries: acute pancreatitis; pancreatic necrosis; ultrasound; CT; MRI; EUS; as well as their combinations in order to narrow the search for the problem. The article examines in detail the methods of radiation diagnostics of pancreatic necrosis (ultrasound; CT; MRI; EUS); which allow us to identify necrosis of the pancreatic parenchyma; the presence of “local” complications of acute pancreatitis and assess the severity. The authors analyze the advantages and limitations of each method; and discuss the features of interpreting the results. In particular; the role of radiological examination methods for assessing the severity of acute pancreatitis was studied in comparison with generally accepted scales: MCTSI; BISAP; APACHE-II; SOFA; Ranson and the C-reactive protein index. Data on diagnostic criteria for pancreatic duct disconnection syndrome were also systematized. The article will be useful for specialists in the field of radiation diagnostics; surgeons and other medical workers in related specialties involved in the treatment of acute diseases of the pancreas.