However, clinical suspicion and fine-needle aspiration with fluid analysis remain the gold standard for treatment determination. Hemorrhagic fluid collections may be more easily recognized on MRI than CT because of the presence of T1 hyperintense methemoglobin, low-signal-intensity hemosiderin rim on T2-weighted images, and signal abnormalities related to hemorrhage that persist longer on MRI than CT. However, in the setting of an abrupt decrease in hemoglobin or hematocrit, an acute bleeding episode would be suspected, and MRI without and with IV contrast with MRCP is currently limited by longer acquisition times. In these patients, who may be unstable in the setting of an acute bleeding episode, a more rapid CT examination is preferred. US Abdomen Gas bubbles within necrotic collections and pancreatic and peripancreatic fluid collections may be seen on transabdominal US; however, CT is more commonly used for the imaging diagnosis of infection, particularly because it may be challenging to differentiate gas in overlying stomach/bowel from gas in a collection by US. US Abdomen with IV Contrast Although CEUS can be used to evaluate complications of pancreatitis, such as splenic artery aneurysm [28], in the setting of an abrupt decrease in hemoglobin or hematocrit, CT angiography is the preferred imaging modality given its rapid acquisition and vascular mapping for interventional or surgical treatment planning. Acute Pancreatitis US Duplex Doppler Abdomen Color Doppler US may be used with traditional grayscale US for evaluation of vascular complications, such as arterial pseudoaneurysms or thrombosis of the portal venous system. Pseudoaneurysms, which most frequently involve the splenic, gastroduodenal, and pancreaticoduodenal arteries, may be identified on a Doppler US examination; however, in the setting of an abrupt decrease in hemoglobin or hematocrit, CT angiography is the preferred imaging modality for assessment of suspected pseudoaneurysm rupture. Variant 6: Acute pancreatitis.
Acute Pancreatitis. However, clinical suspicion and fine-needle aspiration with fluid analysis remain the gold standard for treatment determination. Hemorrhagic fluid collections may be more easily recognized on MRI than CT because of the presence of T1 hyperintense methemoglobin, low-signal-intensity hemosiderin rim on T2-weighted images, and signal abnormalities related to hemorrhage that persist longer on MRI than CT. However, in the setting of an abrupt decrease in hemoglobin or hematocrit, an acute bleeding episode would be suspected, and MRI without and with IV contrast with MRCP is currently limited by longer acquisition times. In these patients, who may be unstable in the setting of an acute bleeding episode, a more rapid CT examination is preferred. US Abdomen Gas bubbles within necrotic collections and pancreatic and peripancreatic fluid collections may be seen on transabdominal US; however, CT is more commonly used for the imaging diagnosis of infection, particularly because it may be challenging to differentiate gas in overlying stomach/bowel from gas in a collection by US. US Abdomen with IV Contrast Although CEUS can be used to evaluate complications of pancreatitis, such as splenic artery aneurysm [28], in the setting of an abrupt decrease in hemoglobin or hematocrit, CT angiography is the preferred imaging modality given its rapid acquisition and vascular mapping for interventional or surgical treatment planning. Acute Pancreatitis US Duplex Doppler Abdomen Color Doppler US may be used with traditional grayscale US for evaluation of vascular complications, such as arterial pseudoaneurysms or thrombosis of the portal venous system. Pseudoaneurysms, which most frequently involve the splenic, gastroduodenal, and pancreaticoduodenal arteries, may be identified on a Doppler US examination; however, in the setting of an abrupt decrease in hemoglobin or hematocrit, CT angiography is the preferred imaging modality for assessment of suspected pseudoaneurysm rupture. Variant 6: Acute pancreatitis.