Early perfusion computed tomography in severe acute pancreatitis: Predicting necrosis and guiding care.

Introduction: Early identification of pancreatic necrosis in severe acute pancreatitis (SAP) is essential for timely intervention and improved outcomes. While prior studies have established the diagnostic value of perfusion computed tomography (PCT), they often lacked early follow-up and clinical integration. This study aims to evaluate PCT not only as a predictive tool for early necrosis but also as a clinically actionable modality for risk stratification and management planning.

Methods: A prospective cross-sectional study was conducted on 50 SAP patients who underwent PCT within 72 h of symptom onset. PCT was performed to assess pancreatic blood flow (PBF), pancreatic blood volume (PBV), mean transit time, and time to peak. Follow-up contrast-enhanced CT was performed at 2 weeks to confirm necrosis. Perfusion parameters were compared between necrosis and non-necrosis groups. Diagnostic performance metrics (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated.

Results: Perfusion defects were identified in 21 patients, with 18 (85.7%) subsequently confirmed to have necrosis. The necrosis group had significantly lower PBF (35.49 ± 21.62 mL/100 mL/min) and PBV (11.16 ± 4.84 mL/100 mL) than the non-necrosis group (125.72 ± 50.37 and 17.67 ± 3.80, respectively, P < 0.05). PCT achieved 100% sensitivity, 90.6% specificity, 85.7% PPV, and 90.6% NPV. Optimal cutoff values were BF ≤57.87 and BV ≤14.90.

Conclusion: PCT provides high diagnostic accuracy and valuable prognostic insight in SAP, allowing for early necrosis detection and patient stratification. Its integration into early assessment may improve outcomes and resource utilization.