Copyright ©The Author(s) 2020.
Artif Intell Med Imaging. Jun 28, 2020; 1(1): 40-49
Published online Jun 28, 2020. doi: 10.35711/aimi.v1.i1.40
Table 1 Key points of clinical and imaging differential diagnosis between acute peripancreatic fluid collection and acute necrotic collection
Key pointsAcute peripancreatic fluid collectionAcute necrotic collection
Clinical severityMostly mild acute pancreatitisModerately severe acute pancreatitis or severe acute pancreatitis
Management algorithmConservative treatment (usually resolves spontaneously without intervention)Likely increased morbidity and intervention rates (drainage or surgical treatment)
Course and prognosisThe hospital stay is usually about one week after onset; a good prognosisHospitalization often lasts from weeks to months; increased infection and mortality rates
CT/MRI imaging patternOccurs only in the setting of interstitial oedematous pancreatitisOccurs in the setting of acute necrotising pancreatitis (including peripancreatic necrosis only)
Location and number of collections on CT/MRIMostly confined to simple retroperitoneal space or interfascial planeMostly in transabdominal-pelvic cavities and multiple spaces or interfascial planes
Shape, size, edgeLinear/strip-shaped, a small amount of collections, clear edgeLarge patchy-shaped, a large amount of collections, unclear or irregular edge
Density/intense, enhancement characteristicsHomogeneous low density/hypointense T1 hyperintense T2 signal; no enhancementMixed features, mainly low density/hypointense T1 /hyperintense T2 signal, containing low density fat/fat signal intensity and low density or hypointense pancreas fragments; fragments are not enhancing
Secondary or concomitant signsRareFrequent secondary infection with “bubble sign” (caused by infection itself or intestinal fistula with adjacent intestine); when a large area of intrapancreatic collections is present, “pancreatic duct disruption syndrome” may occur (further invasive operation is often required)