Vol. 3, Issue 1, Part G (2020)

Introduction and Background: Acute and chronic pancreatitis are common inflammatory conditions of the pancreas that are characterized by different clinical, radiologic, and pathologic manifestations. In order to properly diagnose and treat acute pancreatitis (AP), it is crucial to distinguish it from chronic pancreatitis (CP). When it comes to diagnosing, staging, and monitoring pancreatitis, computed tomography (CT) is indispensable. In this study, we will look at patients with acute and chronic pancreatitis to see how well CT imaging correlates with histologic findings from a radiologic-pathologic perspective.

Materials and Methods: This observational study looked back at 60 patients diagnosed with pancreatitis at Department of Pathology, Gouri Devi Institute of Medical Sciences and Hospital, West Bengal, India from January 2019 to December 2019. All of them had contrast-enhanced CT (CECT) scans and then received histopathologic examination using surgical materials or biopsy. Along with 30 cases of chronic pancreatitis, there were also 30 cases of acute pancreatitis in the cohort. Radiology results evaluated gland dimensions, shape, and pattern of enhancement, presence of necrosis, calcifications, ductal dilatation, pseudocysts, and inflammation around the pancreas. Inflammatory cell infiltration, acinar cell necrosis, fibrosis, ductal alterations, and calcification were the main foci of the pathologic assessment.

Results: Overall, 86.7% concordance was found between CT findings and histopathologic diagnosis in 52 of the 60 individuals examined. There was a high degree of agreement between CT and histology in 27 out of 30 cases of acute pancreatitis (90% concordance). The most common symptoms were enlargement of the glands, several types of enhancement, necrosis in 12 individuals, and stranding of fat around the pancreas. Images showed parenchymal atrophy, calcifications (n=18), ductal dilatation (n=22), and pseudocysts (n=7) in 25 individuals with chronic pancreatitis (n=30), for a radiologic-pathologic association of 83.3% concordance. The main reasons for the 8 cases that did not match up were poor histologic sample or overlapping features in recurring acute and early chronic diseases.

Conclusion: The diagnostic accuracy of CT imaging in distinguishing acute from chronic pancreatitis, when combined with histology, is quite high. While there are limits at early or overlapping stages, the study suggests that CT is useful for assessing disease severity and consequences. Obtaining a conclusive diagnosis and formulating a treatment plan still requires a multidisciplinary approach that takes into account clinical, radiologic, and pathologic data.