CT pancreatic perfusion in pancreatitis

VRU 2023 - 64(5): 823-833

Computed tomographic evaluation of pancreatic perfusion in 10 dogs with acute pancreatitis

Background: Pancreatitis is a common and potentially fatal disease in dogs, and imaging features that can predict its severity and outcome are useful for clinicians. Perfusion CT is a technique that measures changes in pancreatic blood flow and microcirculation, which may indicate ischemia and necrosis.

Study: The objective of this prospective, case-control study was to evaluate pancreatic perfusion using contrast-enhanced CT in 10 dogs with acute pancreatitis and compare it with previously established values obtained in healthy dogs.

Methods: Dogs with acute pancreatitis were diagnosed based on clinical signs, laboratory tests, ultrasound, and cytology. They underwent a full abdominal ultrasound, specific canine pancreatic lipase (Spec cPL), and perfusion CT. Perfusion CT was performed using a 16-slice positron emission tomography-CT scanner and postprocessing software. Perfusion variables such as perfusion, peak enhancement index, time to peak enhancement, and blood volume were calculated for 3-mm and 6-mm slices of the pancreas. The data were analyzed using linear mixed model and Spearman’s rho.

Results: Perfusion values were not significantly different between 3-mm and 6-mm slices. Dogs with acute pancreatitis had a significantly faster time to peak enhancement than healthy dogs on 6-mm slices, and this approached significance on 3-mm slices. Dogs with acute pancreatitis and homogeneous pancreatic enhancement had significantly higher perfusion, faster time to peak enhancement, and greater blood volume compared to healthy dogs and dogs with acute pancreatitis and heterogeneous pancreatic enhancement. Pancreatic perfusion decreased with increased pancreatitis severity. No correlation was identified between Spec cPL and pancreatic perfusion.

Limitations: The study had a small sample size and variable patient factors such as signalment, medications, and anesthesia protocols. The use of a 16-slice CT scanner may have limited the evaluation of the entire pancreas and some regions of pancreatic necrosis. The placement of regions of interest in the pancreas may have influenced the perfusion values obtained, especially in cases with heterogeneous enhancement.

Conclusions: The study preliminarily supported the use of perfusion CT in dogs with acute pancreatitis, as it detected changes in pancreatic microcirculation that correlated with the severity of the disease. Perfusion CT may be a useful tool for earlier identification of pancreatic ischemia and necrosis, and for predicting the clinical course and outcome of acute pancreatitis in dogs.

Transverse CT images of the cranial abdominal region in a dog with acute pancreatitis and heterogeneous pancreatic enhancement depicting placement of ROIs for collection of perfusion data and subsequent generation of perfusion maps. The same slice is shown in each image. On the precontrast CT image (A), the abdominal aorta is selected (cross) and two ROIs are placed in the pancreas (T1 and T2). T1 is placed in a region of pancreatic hypoenhancement relative to the region of placement of T2. Image parameters: 3 mm thickness, FOV 18.8 cm, 512 × 512 matrix, kVp 120, current 120, window width 400, window level 40. Color perfusion maps are generated for the calculation of perfusion (B), peak enhancement index (C), time to peak enhancement (D), and blood volume (E) of the pancreas based on ROI placement in (A). Colors indicate the scale from the lowest (blue) to highest (red) amount of perfusion.

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