Akut Pankreatit Tanı, Takip ve Tedavisinde Radyolojinin Önemi
Özet
Akut pankreatit (AP), hafif bir karın ağrısından geri dönüşümsüz sistemik komplikasyonlara ve ölüme kadar uzanabilen, sindirim enzimlerinin aktif hale gelmesiyle gelişen inflamatuar bir hastalıktır. Tanı; klinik öykü, fizik muayene, laboratuvar (amilaz/lipaz artışı) ve radyolojik bulguların birlikte değerlendirilmesiyle konur. Revize Atlanta sınıflamasına göre AP; interstisyel ödematöz ve nekrotizan pankreatit olarak ikiye ayrılır. İnterstisyel formda pankreasta ödem ve homojen kontrastlanma görülürken, nekrotizan formda kontrast tutmayan nekroz alanları ve heterojen koleksiyonlar saptanır. Hastalık seyrinde gelişen peripankreatik sıvı koleksiyonları zamanla (4. haftadan sonra) psödokist veya duvarla sınırlı nekroza (DSN) dönüşebilir. Tanı ve takipte direkt grafi ve ultrasonografi (US) ilk adımda faydalı olsa da doğrudan morfolojik bilgi sağlayan kontrastlı Bilgisayarlı Tomografi (BT) altın standart kabul edilir. BT şiddet indeksi (BTŞİ), prognozu öngörmede kritik öneme sahiptir. Manyetik Rezonans Görüntüleme (MRG) ise koledokolitiyazis ve koleksiyon içeriğini göstermede BT'ye üstünlük sağlar. Girişimsel radyoloji; enfeksiyon tayini için iğne aspirasyonu, perkütan drenaj ve nekroz debridmanı gibi minimal invaziv "step-up" yaklaşımlarıyla AP komplikasyonlarının tedavisinde ve mortalitenin azaltılmasında hayati bir rol oynamaktadır.
Acute pancreatitis (AP) is an inflammatory disease triggered by the activation of digestive enzymes, presenting a wide clinical spectrum ranging from mild abdominal pain to irreversible systemic complications and death. Diagnosis is established through a combined evaluation of clinical history, physical examination, laboratory findings (elevation in amylase and lipase), and radiological imaging. According to the revised Atlanta classification, AP is divided into interstitial edematous and necrotizing pancreatitis. While the interstitial form displays edema and homogeneous enhancement in the pancreas, the necrotizing form exhibits non-enhancing necrotic areas and heterogeneous collections. Peripancreatic fluid collections developing during the course of the disease can transform into pseudocysts or walled-off necrosis (WON) after the fourth week. Although direct radiography and ultrasonography (US) are beneficial in the initial stages of diagnosis and follow-up, contrast-enhanced Computed Tomography (CT), which provides direct morphological data, is considered the gold standard. The CT severity index (CTSI) holds critical importance in predicting prognosis. Magnetic Resonance Imaging (MRI) offers superiority over CT in demonstrating choledocholithiasis and the components of fluid collections. Interventional radiology plays a vital role in managing AP complications and reducing mortality through minimal invasive "step-up" approaches, including image-guided needle aspiration for detecting infection, percutaneous drainage, and necrotic debridement.
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