TY - JOUR
T1 - The accuracy of pancreatic perfusion computed tomography and angiography in predicting necrotizing pancreatitis
T2 - A systematic review
AU - Smeets, Xavier J. N. M.
AU - Litjens, Geke
AU - Gijsbers, Kim
AU - Prokop, Mathias
AU - Drenth, Joost P. H.
AU - Hermans, John
AU - van Geenen, Erwin J. M.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85049051220&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29894416
U2 - https://doi.org/10.1097/MPA.0000000000001067
DO - https://doi.org/10.1097/MPA.0000000000001067
M3 - Review article
C2 - 29894416
SN - 0885-3177
VL - 47
SP - 667
EP - 674
JO - Pancreas
JF - Pancreas
IS - 6
ER -