Role of computed tomography perfusion in the evaluation of pancreatic necrosis and pancreatitis after endoscopic ultrasound-guided ablation of the pancreas in a porcine model.

Abstract

OBJECTIVES: To evaluate the role of computed tomography (CT) perfusion in detection of pancreatic necrosis and pancreatitis after endoscopic ultrasound-guided ethanol ablation of porcine pancreas and to correlate the evaluation with histopathology. METHODS: Under endoscopic ultrasound guidance, 0.9% saline (control) and ethanol at 60%, 80%, and 100% concentrations were injected into the pancreatic tails of 4 pigs. On day 4, dynamic perfusion CT of the pancreas was performed. Perfusion analysis and evaluation of enhancement characteristics were done and correlated with histopathology. RESULTS: Ethanol injections at 80% and 100% concentrations resulted in focal necrosis surrounded by focal pancreatitis, whereas 60% ethanol injection caused severe focal pancreatitis with microscopic necrosis. The necrotic area revealed reduced blood flow, blood volume, permeability-surface area product, and increased mean transit time compared with pancreatitis and normal tissue (P < or = 0.001). In the control pig, no pancreatitis or necrosis was observed on perfusion images and histopathology. CONCLUSIONS: Pancreatic necrosis and pancreatitis after ethanol injection reduced the tissue perfusion on CT in comparison to normal tissue, with the changes being more substantial in necrosis than pancreatitis. These findings have possible implications in the accurate detection of pancreatic necrosis in patients with severe pancreatitis.