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The Accuracy of Pancreatic Perfusion Computed Tomography and Angiography in Predicting Necrotizing Pancreatitis: A Systematic Review

Smeets, Xavier, J.N.M., MD*; Litjens, Geke, MD; Gijsbers, Kim, MD*; Prokop, Mathias, MD, PhD; Drenth, Joost, P.H., MD, PhD*; Hermans, John, MD, PhD; van Geenen, Erwin, J.M., MD, PhD*

doi: 10.1097/MPA.0000000000001067

Early prediction of necrotizing pancreatitis is important for tailoring treatment, but current scoring systems have moderate accuracy and can be calculated only 24 to 48 hours after disease onset. Evaluation of (micro)circulatory changes in acute pancreatitis at admission by perfusion computed tomography (PCT) or angiography could predict necrosis earlier. Our aim was to systematically review the evidence for angiographic and PCT prediction of necrotizing pancreatitis. We performed a systematic review and searched MEDLINE and Embase. We included cohort studies addressing pancreatic perfusion for prognostication of severity of acute pancreatitis and assessed study quality with a tool specific for diagnostic accuracy studies. Six prospective cohorts with 334 patients were included. Sensitivity of PCT for predicting necrosis ranged from 71% to 100% and specificity from 74% to 100%. The only study directly comparing PCT and angiography found a similar sensitivity (100%) but higher specificity for PCT (90% vs 72%). The included studies had moderate quality. Current studies consistently demonstrate excellent sensitivity and specificity of PCT for early prediction of necrosis. The performance found in our review should be confirmed in larger prospective cohorts as published studies have moderate quality. Furthermore, it should be investigated whether early PCT improves disease course.

From the Departments of *Gastroenterology and Hepatology and

Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

Received for publication September 5, 2017; accepted April 10, 2018.

Address correspondence to: Xavier J.N.M. Smeets, MD, Department of Gastroenterology and Hepatology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (e-mail:

Author contributions: All authors were involved in the design of the study. X.J.N.M.S., G.L., and K.G. acquired data, analyzed and interpreted data, and drafted the manuscript. M.P., J.P.H.D., J.H., and E.J.M.v.G. were involved in analysis and interpretation of the data and critically revised the manuscript. E.J.M.v.G. supervised the study. All authors approved the final manuscript.

The authors declare no conflict of interest.

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