Diffusion weighted imaging in acute pancreatitis; Corelation with CT

Acute pancreatitis is a disease which can be seen in a wide spectrum involving edematous or necrotising form. İn making the diagnosis, CT is still the gold standard modality , likely, for the prognosis of the disease CTSI is still used worldwide. Because of that, in accetance of the patient and for the time after that , too many CT scans is needed to be used. As many centers do, for making acute pancreatitis diagnosis, we use the CT protocol for the pancreas (thin-slice, with i.v contrast medium). But we all know that, CT scan involves too much radiation doses and the negative effects of radiation on the bilogical tissues. İn addition, CT cannot be used in pregnancy, in allergic individuals, or the patients whom the contrast medium is contrendicated. Far beyond that , there are some studies about the contrast medium?s effects on acute pancreatitis, mentions that contrast medium, fastens the progression of necrosis by damaging the perfusion of the pancreatic tissue. Thus, it seems like there is a need for an alternative diagnostic tool. For all this we chose the adequecy of DWI for making the diagnosis of acute pancreatitis for our research.We picked 20 patients with acute pancreatitis for the patient group. The patients who have necrotising acute pancreatitis is not involved fort this study. İn our patient group CT could detect the disease in a significant rate of correctness , only in 3 patients CT found negativmade the ADCe. To all patients we used DWI with b-value =800, additional to routine MR sequences. After that, we made ADC maps for the head, neck, and corpus parts. We picked 20 patients who has no pancreas pathology as control group and made the same procedure on them. After that we compared the results statistically. But we couldn?t reach a significant difference. Thus we cannot give a cut-off value. Furthermore, we compared the ranson scores, amylase-lypase levels, ability in dedection in routine MR sequences, CTSI results of the patient group, each, with the ADC values of them. But no significant difference was found. Then we took off , the grade E grup (n=6), in CTSI scores for the homogenity of the distrubition of data. By this we found significant difference in groups statistically. İn literature , there are some studies indicating that patients who classified as grade E , the developing necrosis is not clear, so we thought this situation might be the reason.İn literature, there is a few of studies indicating the usefullness of DWI in acute pancreatitis diagnosis. İn this sudies, the assesment of diffusion restriction was made by visually. And there are no ADC cut-off values about that. İn a study which includes ADC measurements in abdominal pathologies in a wide spectrum, there are ADC values of only 3 patients who has acute pancreatitis. But like the other sudies, in this study , there are ADC measurements in pancreas masses.Finally, a ADC cut-off value for acute pancreatitis couldn?t have found. But, by excluding the grade E group, there is an significant correlation between the CTSI and ADC values. We think that , DWI can not be the first step diagnostic tool for acute pancreatitis but in chosen groups , it can be an alternative imaging modality.