Evaluation the Role of Dynamic Contrast Enhancement Computed Tomography (DCECT) and Magnetic Resonance Tomography (MRI) as a Prognostic Indicator for Various Treatment of Acute Necrotizing Pancreatitis
This prospective study aimed to improve the results of treatment acute and necrotizing pancreatitis with the use of dynamic computed tomography (DCT) and magnetic resonance tomography (MRI) and defining the role of those diagnostic methods as a prognostic indicator for various surgical treatment of acute and necrotizing pancreatitis. 402 patients were divided into 2 comparable groups. Group 1 - 143 patients with necrotizing pancreatitis, treated during the period from 2002 to 2003. Group 2 - 259 patients, treated during the period from 2004 to 2007. All the patients of Group 2 only underwent dynamic contrast enhanced CT and MRI if needed. The results of DCECT and MRI were evaluating according to Balthazar scale. Both groups underwent either conservative therapy, drainage procedure or conventional operation. The choice of way and kind of surgery based on clinical data and results of dynamic US only in Group 1 but based on clinical data with the DCECT and MRI in Group 2 41(28.7%) patients of the Group 1 underwent only US-guided percutaneus drain on the 3-7th day from the onset of desease. 45(31.4%) patients of the 1stGroup were treated by laparotomy and 39(27.3%) underwent both (US-guided percutaneus drain on the 3-5th day and laparo-tomy on the 14-17th day). 138(53.3%) of the 2-d Group were cured only by the use of US-guided percutaneus drain on the 3-5th day from the onset. Only 16(6.2%) patients from the Group2 needed laparotomy, that was done on the 12-14th day from the admission. The combination of both (US-guided percutaneus drain and open surgery) was done to 44(16.9%) of patients of the Group 2. 18(12.6%) and 57(22,1%) patients were cured with conservative treatment alone in Group 1 and Group 2, accordingly. The mortality rate in the 1st group was 35.2% and 14.4% - in second. This way of diagnostic procedure included DCECT and MRI proved to be a safe and accurate method not only for identifying and localising pancreatic and peripancreatic necrosis, but for making decision for variable treatment techniques in patients with acute and necrotizing pancreatitis.