INCORRECT ESTIMATION OF SEVERITY OF ACUTE-PANCREATITIS BY CONTRAST-ENHANCED COMPUTED-TOMOGRAPHY

Background and Aims: In acute pancreatitis, contrast-enhanced CT is wi dely accepted to give reliable information in the early assessment of severity. This study critically evaluates the clinical data, outcome, and CE-CT findings in patients with incorrect radiological estimation of the severity of the condition. Material and Methods: All patients s uspected of having severe pancreatitis underwent contrast-enhanced CT. Clinical data and CE-CT findings of 341 patients were re-examined. Re sults and Conclusions: In 28 patients (8.2 %) the radiological diagnos is was inconsistent with the clinical findings. The most common reason - in 20 of the 28 patients (71.4 %) - for failure to estimate the sev erity of pancreatitis was partial necrosis of the gland. In severe cas es the partial necrosis was overlooked in nine patients (32.1%). In mi ld cases clinical significance of partial necrosis - overestimated as representative for the whole gland and technical failure both explaine d the incorrect interpretation in six (21.4 %) patients; and in five p atients (17.9 %) intermediate patchy enhancement was incorrectly regar ded as low. The misleading estimation remained inexplicable in only tw o (7.1 %) patients. These results emphasize adequate assessment of CE- CT and inclusion of all areas of the pancreas in the estimation of enh ancement.