Imaging study of enhanced CT combined with clinical indicators in the differential diagnosis of severe and moderately severe acute necrotizing pancreatitis

Purpose: To analyze the differential diagnosis ability of enhanced CT combined with clinical indicators in patients with acute necrotizing moderately severe and severe pancreatitis.

Methods/Materials: A total of 241 patients with acute necrotizing pancreatitis who were hospitalized from May 2016 to June 2024 were selected and divided into severe group and moderate-severe group. The clinical indicators and enhanced CT imaging indicators were collected and the differences in the indicators between the two groups were compared. The risk factors of acute necrotizing severe pancreatitis were analyzed by multivariate Logistic regression, and ROC was used to evaluate the efficacy of independent risk factors in the differential diagnosis of acute necrotizing moderately severe and severe pancreatitis.

Results: Albumin and serum calcium were significantly lower than those in the moderate-severe group ( P < 0.05 ). The area of pancreatic parenchymal necrosis and the anatomical location of acute necrotizing accumulation ( ANC ) in the retroperitoneal space were statistically significant between the two groups ( P < 0.05 ). Multivariate Logistic regression analysis showed that age, WBC, serum creatinine, MCTSI score, and ANC in the right perirenal space were independent risk factors for patients with acute necrotizing severe pancreatitis ( P < 0.05 ). The area under the curve ( AUC ) of age, serum creatinine, albumin, serum calcium, MCTSI score, ANC in the right perirenal space, and the combined differential diagnosis of each index in the moderate-severe group and the severe group were 0.637, 0.617, 0.698, 0.706, 0.650, 0.594, 0.816, respectively. The AUC of the combined differential diagnosis of each index was 0.816 ( 95 % CI: 0.762-0.870 ), and the sensitivity and specificity were 0.761 and 0.758, respectively ( P < 0.001 ).

Conclusions: The age, WBC, serum creatinine, and MCTSI scores of patients with acute necrotizing severe pancreatitis were significantly increased, which were independent risk factors together with ANC located in the right perirenal space. The combination of the above indicators was the best in the differential diagnosis of acute necrotizing moderately severe and severe pancreatitis.