• Atul B Shinagare, Ivan K Ip, Ali S Raja, V Anik Sahni, Peter Banks, and Ramin Khorasani.
• Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA, ashinagare@partners.org.
• Abdom Imaging. 2015 Feb 1; 40 (2): 272-7.

PurposeAssess the utility of CT and MRI in patients with acute pancreatitis (AP) presenting to emergency department (ED).Materials And MethodsIn this Institutional Review Board-approved retrospective study, we identified all patients with AP from March 2012 through February 2013 in ED of a teaching hospital with approximately 60,000 annual visits. Patients were initially identified via ICD-9 code for AP (577.0); diagnosis was confirmed by chart review using established diagnostic criteria (presence of two of the following: typical abdominal pain, elevated lipase/amylase >3 times normal, or imaging findings of pancreatitis). Abdominal CT or MRI obtained in the ED and within 24 h of admission was reviewed by a fellowship-trained abdominal radiologist.ResultsOf 101 patients admitted with AP (60 women, 41 men; mean age 52 years, range 20-89), 63 (62.4%) underwent imaging; only one (1.6%) showed pancreatic necrosis. 88 (87.1%) patients could have been clinically diagnosed without imaging based on presence of abdominal pain and elevated laboratory values; 13 (12.9%) required imaging for diagnosis. Of 88 patients who met AP diagnostic criteria without imaging, 50 (56.8%) nonetheless underwent imaging, with AP without necrosis seen in 34 (68.0%), pancreatic necrosis in one (2.0%), sequelae of prior AP in four (8.0%), and no abnormality in 11 (22.0%).ConclusionEarly imaging is common in patients with AP, even when the diagnosis can be established based on non-imaging criteria, rarely demonstrating pancreatic necrosis. Reducing overuse of early imaging in patients with confident diagnosis of AP may improve quality and reduce waste.

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