Efficacy of Perfusion Computed Tomography in Early Prediction of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for diagnosing and treating pancreaticobiliary diseases, but post-ERCP pancreatitis (PEP) is a common and potentially severe complication. Perfusion computed tomography (CT) is a method for analyzing blood flow by capturing sequential images after rapid intravenous contrast injection, however, its usefulness in the early detection of PEP is unclear. This study aimed to assess whether ERCP followed by perfusion CT could predict PEP at an early phase. Methods: This single-center prospective study included 49 patients (25 women, 24 men; median age, 70 y) who underwent ERCP, who were at high risk for PEP, and who underwent perfusion CT within 2 hours after ERCP. All patients underwent perfusion assessment of blood volume (BV), blood flow (BF), mean transit time (MTT), and time to peak (TTP). Results: PEP occurred in 13 patients (26.5%). The PEP group had higher BF and shorter MTT and TTP than the non-PEP group ( P <0.01). Receiver operating characteristic analysis identified BV, BF, MTT, and TTP as good predictive markers for PEP (with areas under the curve of 0.624, 0.739, 0.735, and 0.748, respectively). The respective sensitivity and specificity for the diagnosis of PEP were as follows: BV, 84.6% and 50.0%; BF, 61.5% and 91.7%; MTT, 84.6% and 66.7%; TTP, 84.6% and 69.4%; serum amylase, 61.5% and 86.1%. The sensitivity and specificity of TTP combined with serum amylase increased to 76.9% and 88.9%, respectively. Conclusions: Early perfusion CT findings after ERCP could predict PEP development in high-risk patients.