Fat-modified computed tomography severity index (CTSI) is a better predictor of severity and outcome in patients with acute pancreatitis compared with modified CTSI

• Published in: Abdominal imaging 2020-05, Vol.45 (5), p.1350-1358
• Main Authors: Gupta, Pankaj, Dawra, Saurabh, Chandel, Karamvir, Samanta, Jayanta, Mandavdhare, Harshal, Sharma, Vishal, Sinha, Saroj Kant, Dutta, Usha, Kochhar, Rakesh
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adult; Clinical outcomes; Computed tomography; Contrast Media; Diagnostic systems; Drainage - methods; Female; Gastroenterology; Hepatology; Humans; Imaging; Intra-Abdominal Fat - diagnostic imaging; Iohexol; Length of Stay - statistics & numerical data; Male; Mathematical analysis; Medical prognosis; Medicine; Medicine & Public Health; Pain; Pancreatitis; Pancreatitis - diagnostic imaging; Pancreatitis - mortality; Pancreatitis - therapy; Parameters; Predictive Value of Tests; Prognosis; Radiology; Retrospective Studies; Severity of Illness Index; Special Section: Pancreatitis; Survival Rate; Tomography, X-Ray Computed - methods; Training
• ISSN: 2366-004X; 2366-0058
• DOI: 10.1007/s00261-020-02473-y

Background The amount of intra-abdominal fat on CT correlates positively with the severity of acute pancreatitis (AP). The objective of the study was to evaluate a fat-modified CT severity index (FMCTSI) and compare its performance with MCTSI. Materials and methods For this retrospective study, 99 patients with AP who underwent contrast-enhanced CT between 3 and 7 days after pain onset were divided into a training cohort ( n  = 75) and a validation cohort ( n  = 24). MCTSI was calculated. The total adipose tissue (TAT), visceral adipose tissue (VAT), and total to visceral fat ratio (TVFR) were computed using semi-automatic software. These parameters were given a score of 1–3. FMCTSI was calculated by adding the fat score to MCTSI. Concordance for diagnosing the severity of AP was assessed. Areas under receiver operating characteristic curves (AUC) for predicting clinical outcomes were compared between FMCTSI and MCTSI. The diagnostic performance of the FMCTSI in the validation cohort was also evaluated. Results In the training cohort, our proposed FMCTSI performed better than MCTSI for all the outcome parameters. The highest concordance for the severity of AP was achieved for VAT-MCTSI. For all outcome parameters, the highest AUC was seen for TVFR-MCTSI. In the validation cohort, the FMCTSI achieved diagnostic performance similar to the training cohort with the highest AUC for TVFR-MCTSI. Conclusion FMCTSI is a better CT index than MCTSI for predicting the severity and clinical outcomes of AP. Among the various FMCTSI parameters, TVFR-MCTSI is the best performer.