CT findings of walled-off pancreatic necrosis (WOPN): differentiation from pseudocyst and prediction of outcome after endoscopic therapy |
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Authors: | Naoki Takahashi Georgios I Papachristou Grant D Schmit Prabhleen Chahal Andrew J LeRoy Michael G Sarr Santhi Swaroop Vege Jayawant N Mandrekar Todd H Baron |
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Institution: | (1) Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA;(2) Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA;(3) Department of Surgery, Division of Gastroenterologic and General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA;(4) Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA;(5) Present address: Department of Internal Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA;(6) Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA |
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Abstract: | Computed tomography (CT) findings that may differentiate walled-off pancreatic necrosis (WOPN) from pancreatic pseudocyst
were investigated. CT examinations performed before endoscopic therapy of pancreatic fluid collection (PFC) in 73 patients
(45 WOPN, 28 pseudocysts) were evaluated retrospectively by two radiologists. PFC was evaluated for size, extension to paracolic
space, characteristics of wall and internal structure. The pancreas was evaluated for deformity or discontinuity, and pancreatic
duct dilation. CT findings that were associated with WOPN or pseudocyst were identified. CT score (number of CT findings associated
with WOPN minus number of findings associated with pseudocyst) was calculated for each PFC. PFC was categorized as WOPN or
pseudocyst using a CT score threshold. Larger size, extension to paracolic space, irregular wall definition, presence of fat
attenuation debris in PFC, pancreatic deformity or discontinuity (P < 0.05–0.0001) were findings associated with WOPN. Presence of pancreatic duct dilation was associated with pseudocyst. Using
a CT score of 2 or higher as a threshold, CT differentiated WOPN from pseudocyst with an accuracy of 79.5–83.6%. Thus, CT
can differentiate WOPN from pseudocysts. |
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Keywords: | Pancreatitis CT Pancreatic necrosis |
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