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Computed tomographic angiography and ultrasonography in the diagnosis and evaluation of acute pancreatitis in dogs

French, John M., Twedt, David C., Rao, Sangeeta, Marolf, Angela J.
Journal of veterinary internal medicine 2019 v.33 no.1 pp. 79-88
angiography, complications (disease), computed tomography, diagnostic techniques, dogs, hospitals, humans, pancreas, pancreatitis, patients, portal vein, prognosis, relapse, risk, therapeutics, thrombosis, triacylglycerol lipase, ultrasonics, ultrasonography
BACKGROUND: Acute pancreatitis in dogs is an under‐diagnosed disease. Current diagnostic methods are insufficient at identifying sequelae and lack prognostic capability. Computed tomographic angiography (CTA) is accurate for diagnosis and prognostication of pancreatitis in humans. OBJECTIVES: In comparison to ultrasound (US), CTA will (1) better diagnose more severe pancreatitis and sequelae and (2) provide assessment of patient outcome by identification of pancreatic contrast enhancement patterns. ANIMALS: Twenty‐six client‐owned dogs suspected to have acute pancreatitis. METHODS: US and CTA examinations performed at time of admission were compared to determine the detection of pancreatic changes and sequelae. CTA findings also were compared to outcome indicators for prognosis of dogs with acute pancreatitis. Specific canine pancreatic lipase (cPL) samples were obtained and compared with CTA findings. RESULTS: Ten of 26 dogs had heterogeneous contrast enhancement of the pancreas. Compared to US, CTA better identified portal vein thrombosis (P = .003). Patients with heterogeneous contrast enhancement had longer hospitalization (P = .01), including hospital stays for >5 days (P = .02), had more relapses, and were more likely to have portal vein thrombosis (P = .002). Patients with heterogeneous contrast enhancement had increased spec cPL (P = .006). CONCLUSIONS AND CLINICAL IMPORTANCE: In comparison to US, CTA better identified dogs with more severe acute pancreatitis and those with portal vein thrombosis, factors that may predict longer hospitalization and increased risk of relapse. The presence of heterogeneous contrast enhancement and portal vein thrombosis may change therapy for patients with acute pancreatitis.