Evaluation of computed tomography value in early diagnosis of acute pancreatitis- A Prospective Observational Study

Background: Acute pancreatitis is a disease with high rate of morbidityand mortality and is known to run an unpredictable course. Computedtomography is the gold standard technique not only for its global pictureof the pathology and for the non-invasive method of evaluating themorphology of pancreas and peripancreatic regions in an acute situation.The purpose of the study was to determine the value of computedtomography evaluation in early diagnosis of severity, differencesbetween pancreatitis & acute pancreatitis caused by mass lesions.Methodology: A prospective study comprise of 60 patients on clinicalsuspicion/diagnosis of acute pancreatitis, altered biochemical parameters(serum amylase, serum lipase) in favor of acute pancreatitis,Ultrasonography suggestive of acute pancreatitis and known case ofchronic pancreatitis with features of acute symptoms referred toDepartment ofRadiology & Imaging, BSMMU, Dhaka, Bangladesh fromJanuary to June 2024. Plain and post-contrast series of the abdomen andpelvis were taken.Results: Outof 60 patients, 45 were male and 15 were female patients.Among these edematous pancreatitis was in 20% patients and pancreaticnecrosis was in 23.3% patients. Other features like diffuse/focalpancreatic enlargement in (75%), peri-pancreatic fat stranding in(63.3%) and peri-pancreatic fluid collection in (40%). Among thisalcohol was the most common cause of AP (83.3%). The accuracy andsensitivity of serum amylase and serum lipase in diagnosing AP were40% and 63.3% respectively with CT showing 100% accuracy andsensitivity. Modified CT severity index was classified as mild (2 and 4),moderate (6) and severe (8 and 10) of which majority were mild (66%),moderate (22%) and severe (12%).Conclusion: Computed tomography is a sensitive, non-invasive imagingin early diagnosis and staging of severity of acute pancreatitis whichhelp in prediction of prognosis of the disease. It helps to differentiatebetween edematous and necrotizing pancreatitis as serum lipase andamylase levels do not help to differentiate the type of AP. Modified CTseverity index helps in evaluating the percentage pancreatic necrosis andto predict the possibility of developing local and systemic complicationsand necessity of tertiary care.