PERFUSION COMPUTED TOMOGRAPHY: NEW HORIZONS IN DIAGNOSING DISEASES OF THE PANCREAS

Abstract. Introduction. According to the World Health Organization, the most common disease of the pancreas is acute pancreatitis, which can lead to the development of pancreatic necrosis. In this regard, early diagnosis and assessment of the pancreatic necrosis risk development are of paramount importance for choosing adequate treatment approaches and improving outcomes for patients. Radiological research methods have become the “gold” standard in clinical practice for the primary diagnosis of pancreatic diseases. Contrast-enhanced computed tomography has traditionally been used to visualize the pancreas and assess the extent of inflammation and necrotic changes. However, standard computed tomography has limitations in assessing tissue perfusion, which is an important aspect of the pathophysiology of acute pancreatitis. Perfusion computed tomography of the pancreas has become a colossal breakthrough in radiation imaging, has become widespread as a method that allows the quantitative assessment of blood supply to the pancreas, including information about microcirculation, and it can be used for the early detection of ischemic changes that precede tissue necrosis in the pancreas. Aim. To study the capabilities of perfusion computed tomography and computed tomography angiography of the pancreas for evaluating the area of pancreatic necrosis in acute pancreatitis, with the aim of improving diagnosis and planning treatment measures to minimize the consequences and increase patient survival. Materials and Methods. A single-center examination was carried out on 42 patients (18 women, 24 men, mean age 38±2 years) with suspected acute pancreatitis. All patients underwent perfusion computed tomography within the first 3 days; over the next 3-5 days, computed tomography angiography of the pancreas was performed with bolus intravenous contrast to confirm the development of necrotic changes. Results and Discussion. After performing perfusion computed tomography within the first 3 days from the onset of symptoms, areas of ischemic damage to the pancreas tissue were identified in 16 (38.1%) out of 42 patients. After computed tomography angiography, the development of necrotic changes was confirmed in 7 patients (16.7%). The localization of the necrosis zone detected in computed tomography coincided with the ischemic zones on the color hemodynamic maps of perfusion computed tomography.

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