Multiphasic CT in Complicated Acute Pancreatitis

Background: Acute pancreatitis is a common inflammatory disorder with a variable clinical course, and complicated cases may develop pancreatic necrosis, fluid collections, vascular abnormalities, and gastrointestinal complications. Multiphasic computed tomography (CT) provides comprehensive assessment of pancreatic and vascular pathology and may assist in severity assessment and therapeutic planning. This study evaluated the role of multiphasic CT in the assessment of complicated acute pancreatitis. Material and Methods: A hospital-based, observational study was conducted among 110 adult patients with clinically diagnosed complicated acute pancreatitis. Patients underwent Multiphasic Contrast-enhanced CT, including unenhanced, pancreatic/arterial, and portal venous phases. Pancreatic and peripancreatic abnormalities, necrosis, fluid collections, vascular complications, and extrapancreatic findings were documented. Modified CT Severity Index (MCTSI) scores were calculated. CT findings were correlated with clinical severity, management, follow-up, and in-hospital outcomes. Results: The mean age was 46.8 ± 14.2 years, with males comprising 65.5% of patients. Alcohol-related pancreatitis was the commonest etiology (41.8%). Peripancreatic fat stranding (93.6%) and pancreatic enlargement (83.6%) were the most frequent CT findings, while pancreatic/peripancreatic necrosis was observed in 55.5%. Ascites and pleural effusion were present in 60.9% and 46.4%, respectively. Vascular complications were identified in 29.1%, with splenic vein thrombosis (15.5%) being most frequent. Severe MCTSI was observed in 50.0% of patients. Pancreatic necrosis increased significantly with MCTSI severity (p<0.001). ICU admission occurred in 26.4%, intervention was required in 47.3%, and in-hospital mortality was 10.0%. Conclusion: Multiphasic CT effectively characterized the diverse pancreatic, peripancreatic, and vascular complications of acute pancreatitis. It provided important information regarding disease severity and supported clinical and therapeutic decision-making.

Keywords: Acute pancreatitis; Multiphasic Computed Tomography; Pancreatic necrosis; Vascular complications; Modified CT Severity Index; Peripancreatic collections; CT severity.