Keywords:
Infection, Cysts, Acute, Diagnostic procedure, Contrast agent-intravenous, Colonography CT, Ultrasound, MR, CT, Pancreas, Abdomen, Liver
Authors:
A. Arablinskiy, J. Sidorova; Moscow/RU
DOI:
10.1594/ecr2012/C-1056
Purpose
The latest workstations with upgraded software for analysis CT data with MPR VR reconstruction allows to receive clear information about the localization of collections,
size of their extension,
their internal structure and interrelations with surrounding structures.
MSKT with intravenous bolus enhancement allows getting full information about the true sizes and the localizations of pancreatic necrosis.
(fig 1)
MRI is used as an addition to MDCT and allows to define the size and localization of seqestrums in collections.
We also can clearly differentiate the liquid and infiltration in the retroperitoneal fat by the MRI.
(fig 2)
Modern surgeons are emphasizing the importance of the definition the types of exudate localization.
We know three types of the exudates spreading direction: central,
right and left types.
This is clearly reproduces on the MPR.
(fig 3)
Unfortunately there are no common principles of the interpretation such of great amounts of the diagnostic information.
The misunderstanding between the surgeons and radiologists leads to the not coordinated actions.
Surgeons during planning the treatment rely upon their own ideas about the changes found on diagnostic images instead of radiological descriptions.
It leads to the incompletely used so accurate diagnostic information.
Certainly term the “acute fluid collection” which defined at the international symposium on acute pancreatitis held in Atlanta in 1992 is very poor to describe all variety changes revealing on the MDCT and MRI.
Term of Atlanta classification the “acute pseudocyst” may be ambiguous as so as reflects different processes.
CT severity assessment score adapted by Bathtazar et al.
(1985,
1990) not elucidates variety of collections localization and their structure.
Purpose of this poster to present the results of analysis pre-operative and post-operative CT and the MRI of patients with acute pancreatitis.
We analyzed CT and MRI data of the dynamic observation of 250 patients with acute pancreatitis who underwent surgery.
We managed to disclose main trends of pancreatic necrosis and fluid collections evolution.
We developed an upgraded description protocol of peripancreatic changes.
In this protocol we have defined anatomical localization of fluid collections towards the peritoneum,
fascias and surrounding organs.
We have also defined degrees of the pancreatic necrosis and pathological exudate spread extension in the retroperitoneal fat.
We have also introduced an improved scheme of the radiological examination and the radiological report of patients with acute pancreatitis.
We then evaluated its application.
The received information allows surgeons to choose the optimal surgical strategy.