A Comparative Ananysis between Ultrasonography and computed Tomography in Evaluation of Acute Pancreatitis.

TITLE: A Comparative Ananysis between Ultrasonography and computed Tomography in Evaluation of Acute Pancreatitis. Abstract : Background : The present study aims to study  ct & us findings  among 60 patients suffering with acute pancreatitis METHODOLOGY This is a comparative study, Study population consisted of patients presenting in the emergency room with constellation of symptoms, signs, and laboratory data and imaging studies consistent with pancreatitis. This study was carried out at Government General Hospital, Guntur in the Department of Radiodiagnosis from November 2013 to August 2015. Study included 60 patients who presented with clinical, biochemical and imaging findings satisfying the Practice guidelines in acute pancreatitis- 2013, American college of Gastroenterology Ultrasonography and computed tomography was carried out in all the 60 cases ,the pancreas was evaluated and the following findings were noted. Results: The overall visualisation of pancreas was far better by CT than by ultrasound examination. In a study by Silverstein et al on 102 patients good to excellent visualisation of pancreas was found in 64% of CT scans as compared to 20% of sonographic studies. With improvements in technology visualisation of the pancreas is better on both modalities. This study showed that the pancreas is visualised in as many as 77% on ultrasonography and in 100% of patients on CT in acute pancreatitis. The sensitivity of ultrasound in detecting acute pancreatitis in the present study is 73% In a study conducted by Adrienne van et al the sensitivity was 21-57% The sensitivity of CT in detecting acute pancreatitis in the present study is 96%.Of the 60 cases 58 showed changes in size of the pancreas(i.e bulky),the remaining two cases had normal sized pancreas .These 2 patients had clinical and laboratory findings suggestive of acute pancreatitis. In a study by Andrienne van Randen et al, the sensitivity of CT in detecting acute pancreatitis is 51-85% 12 . CONCLUSION Maximum number of cases were between 21 -40 years of age.Abdomial pain in the epigastric and periumbilical region radiating to the back ,nausea and vomiting were the most frequent presenting complaints. Pancreas was visualized in 76% of the patients on ultrasound examination and in 100% patients on CT examination. The most common ultrasonographic findings were alteration in the size and echogenecity of pancreas . Bulky and hypoechoic pancreas was considered diagnostic of acute pancreatitis on ultrasonography. Duct dilatation and calcification were seen in patients who had acute on chronic pancreatitis. Ultrasonography has a sensitivity of 76% in diagnosis. The most common CT features were enlarged pancreatic size and presence of peripancreatic fat stranding. Extra pancreatic spread of inflammation and complications were better assessed by computed tomography. Computed tomography had a sensitivity of 96% in diagnosing acute pancreatitis. Thus both Ultrasonography and Computed tomography have role in diagnosing acute pancreatitis and both are complementary to each other,although CT was better in staging the disease and assess the prognosis.