- CT is indicated if the diagnosis is equivocal, to rule out alternative intra-abdominal catastrophes
- In acute severe pancreatitis, CT is used to detect and stage regional complications such as pancreatic necrosis:
- Should be performed in those with new or persisting organ failure
- If the diagnosis is clear, it may be appropriate to delay CT imaging for at least 48–72 h after onset of symptoms because the full extent of pancreatic necrosis cannot be determined until this time
- Patients with SAP often require multiple contrast-enhanced CT scans to assess progress and screen for complications
- The risk of contrast nephropathy should be considered in patients who have already had septic, hypoxaemic, and ischaemic insults to the kidneys.
International Guidelines
- The indication for initial CT assessment in acute pancreatitis can be:
- Diagnostic uncertainty
- Confirmation of severity based on clinical predictors of severe acute pancreatitis
- Failure to respond to conservative treatment or in the setting of clinical deterioration
- Optimal timing for initial CT assessment is at least 72-96 hours after onset of symptoms
- Follow up CT or MR in acute pancreatitis is indicated when there is a lack of clinical improvement, clinical deterioration, or especially when invasive intervention is considered