| [ Summary ] |
To reduce mortality rates in patients with severe acute pancreatitis, diverse types of researches are being conducted. Grading of the severity of the early phases of this disease is very important in order to undertake treatment appropriate to the patient's clinical state. Computed tomography can provide imformation about the anatomy of the pancreas and the retoroperitoneum. Numerous published studies have reported the accuracy of this tool in the diagnosis of pancreatic disease. Furthermore, since 1982, some authors have been studying the relationship of early CT findings to the clinical course of patients with acute pancreatitis. They have concluded that early CT findings could be a predictive factor for patients with acute pancreatitis. It has also been noted that since 1987 CT findings have been added to the Japanese criteria for severe acute pancreatitis. Previous research on early CT findings of acute pancreatitis confirms that the degree of pancreatic necrosis and the extent of inflammatory changes in the surrounding area is associated with the overall morbidity. Recently several studies have reported that CT grading, using the Japanese criteria for acute pancreatitis could not predict mortality. This CT grading is composed of factors which express the degree of pancreatic necrosis and the extent of inflammatory changes in the surrounding area. This grading system is generally reasonable in light of previous reports of predictive ealry CT findings, but it has some minor defects. For example, CT examinations should be performed supposing contrast material for accurate judgement of pancreatic necrosis. Categorization of the extension of inflammatory changes should be clarified. Modification of the present system is necessary. However, we would like to emphasize that CT findings provide very useful imformation concerning the clinical course of patients with pancreatitis. In previous reports, the important points of CT findings were indentified. Observers should try to carefully gather predictive factors from a great number of CT findings. |