From the Research
CT abdomen with or without contrast is not the primary diagnostic tool for pancreatic insufficiency, and the preferred tests for diagnosing pancreatic insufficiency are fecal elastase-1 test, 72-hour fecal fat collection, and direct pancreatic function tests like secretin stimulation test. The diagnostic approach for pancreatic insufficiency should prioritize functional tests that directly measure enzyme output or activity. CT imaging may be useful in identifying structural abnormalities of the pancreas that could cause insufficiency, such as chronic pancreatitis, pancreatic cancer, or cystic fibrosis-related changes, but it cannot directly assess pancreatic enzyme production or function 1.
According to the guidelines for the diagnostic cross-sectional imaging and severity scoring of chronic pancreatitis, computed tomography (CT) is often the most appropriate initial imaging modality for evaluating patients with suspected chronic pancreatitis, but it cannot exclude a diagnosis of chronic pancreatitis nor can it be used to exclusively diagnose early or mild disease 1. Magnetic resonance imaging (MRI) and MR cholangiopancreatography (MRCP) are superior in these cases.
The risk of contrast-induced nephropathy is a consideration when deciding whether to use contrast in CT imaging, particularly in patients with pre-existing renal impairment or risk factors such as diabetes, advanced age, vascular disease, and use of certain concurrent medications 2. However, the incidence of contrast-induced nephropathy is very low in the general population, and the benefits of diagnostic information gained from contrast-enhanced CT in assessing acute abdomen are fundamental in some clinical scenarios 2.
In the context of pancreatic insufficiency, the focus should be on diagnosing the underlying cause of the insufficiency rather than solely on the insufficiency itself. The use of CT abdomen with or without contrast should be reserved for evaluating underlying structural causes or complications of pancreatic insufficiency, rather than as a primary diagnostic tool. This approach is supported by the most recent and highest quality studies, which emphasize the importance of functional tests in diagnosing pancreatic insufficiency 1, 2.
Key points to consider in the diagnostic approach for pancreatic insufficiency include:
- Functional tests such as fecal elastase-1 test, 72-hour fecal fat collection, and direct pancreatic function tests like secretin stimulation test are the preferred diagnostic tools.
- CT imaging may be useful in identifying structural abnormalities of the pancreas but cannot directly assess pancreatic enzyme production or function.
- The risk of contrast-induced nephropathy should be considered when deciding whether to use contrast in CT imaging.
- The diagnostic approach should prioritize functional tests and reserve imaging studies for evaluating underlying structural causes or complications.