 Hello, everyone. My name is Dr. Prakati Jain, junior resident in Dr. Wittler, V.K. Parthal Medical Unit, Ahmed Nagar, under the guidance of Dr. Sushil Khacharwarsar, the Jodi and Drugs of the Department of Radio Diagnosis. My topic for today is the study of CDE imaging of acute pancreatitis in adolescent population. Introduction. Acute pancreatitis is not necessarily a variant disease even in adolescents, maybe in life-threatening if it is severe. Hence, while determining the differential diagnosis of abdominal discomfort in adolescents, acute pancreatitis should always be taken into account when necessary. Urgent treatment should be initiated. CDE scanning together with ultrasound is essential for diagnosing acute pancreatitis. CDE is useful to evaluate any extra pancreatic lesions, monitor the clinical score, course and assess severity. In particular, CDE is superior for early assessment of acute pancreatitis when ultrasound findings are non-specific because of abdominal gasses. Aim to determine the value of CECT in evaluation of pancreatitis in adolescent population to determine underlying positive factors. CECT is the modality of choice for diagnosis and grading of pancreatitis. Protocol three phases are taken, non-enhancing phase, pancreatic phase that is 20 to 40 seconds and potluminous phase at 55 to 45 seconds, non-enhancing phase useful in detecting calcification on a calculator. Also, the initial non-enhancing study is done. Pancreatic pancreatitis is an optimal phase for assessing the necrosis because normal pancreatic tissue enhances greatly during this phase and subsequent imaging with CDE is generally performed using a single phase technique in the potluminous phase. CDE features pancreas enhance uniformly in mild acute pancreatitis and may be normal or enlarged with variable amount of increased admonition in the adjacent fat termed as straining. Local edema is a common finding and may extend along the mesotree, mesocolon, hepato-dodinal ligament or into peritoneal spaces. Extension of edematous fluid into the anterior peri-renal space may create a mass effect and a halosine with sparing of the very nephric fat. Peri-pancreatic fluid collection consists of exudate peri-pancreatic fat tissue necrosis or hemorrhage. Non-enhancement of all or part of gland is termed as necrosis. CDE is 100% specific for necrosis if greater than 30% of the gland is non-enhancing. Balthazar score or CT severity index was developed in early 1990s by Emry Balthazar. CT severity index is grading system used to determine the severity of acute pancreatitis has maximum of 10 points. It is a sum of Balthazar grade points and necrosis score. As mentioned in the table below, CT grades, first normal pancreas is greater as 0, edematous pancreatitis as 1. Edematous pancreatitis with mild extra pancreatic changes greater as 2. Severe extra pancreatic changes including one fluid collection as 3. Multiple or extensive peri-pancreatic collection as 4. Necrosis if none 0 less than 1 third 2 more than 1 third less than half 4 and more than half 6. Modified CVC with CT severity index it correlates more closely with patient of the measures. Modified CT severity index is CT grade plus percentage necrosis plus extra pancreatic complications as shown in the table below. My results I had taken 30 cases in the study and from which 19 patients were male 11 patients were female. Based on the age group that is less than 13 years of age there was one patient 13 to 16 years of age there were 12 patients more than 16 years of age there were 17 patients. Based on the causes maximum cause maximum number of patient had idiopathic cause by alcohol followed by delirium and hyperlipidemia. The least percentage was involving the hyperparatharotism pancreatic activism, blood trauma, drug related and smoking. CT findings in acute pancreatitis as shown below in my patients peri-pancreatic fat standing was present in 21% of the 21 cases and absent in 9 cases therefore 70% of the cases. Diffuse of focal pancreatic enlargement was seen in 86.6% of the cases peri-pancreatic fluid collection was seen in 50% of the cases. This is an accident CT stand image shows showing bulky pancreas with evidence of peri-pancreatic and mesentry fat standing. You can see this. Another CT stand image showing acute peri-pancreatic fluid collection in vitalkute pancreatitis. You can see irregular borders, heterogeneous pancreatic parenchyma, fairly homogenous, hypodense consistent fluid peri-pancreatic fluid collection. Distribution of patients according to the modified CT severity score about 20% of the patients were seen at score 2, 20% of the patients were seen with score 4, 13.3% of cases were seen with score 6 and 26.6% cases seen with score 8 and 20% of the patients seen with score 10. Now the scores you know, they are divided into three groups, mild, moderate and severe, mild score between 2 to 4, moderate 6 and severe 8 to 10, from which 40% of the cases were seen as mild, 13.3 as moderate and 46.6% cases were included in severe. Peri-pancreatic necrosis was seen in 87.5% of the severe cases and 12.5% of the moderate cases. This is a CT stand image showing bulky pancreas with non-enhancing necrotic areas in the body and tail of pancreas. This suggests of necrotizing pancreatitis. In my discussion, the study conducted in 30% of the adolescent patient diagnosed with acute pancreatitis were included in the study. These patients underwent CT of abdomen pelvis and were graded according to the modified CT severity index. Maximum number of patients were between the age group of 16 to 19, followed by 13 to 16. Minimum age group was 11 years of age, maximum 19 years of age. Therefore, the main age was 16 years. 19 patients were male, 11 patients were female. There was no association with age and gender between severity of pancreatitis. There was a study conducted by Lankesh in 602 patients of acute pancreatitis that showed no correlation with age and gender and severity of acute pancreatitis. Idiopathic pancreatitis was the most common variety of acute pancreatitis seen in 11% of the seen and maximum number of the patients followed by alcoholics, followed by two patients who suffered by biliary pancreatitis, out of which one patient suffered with thalassemia and the other suffered from sickle selenemia. Two patients suffered from hyperlipidemia while hyperparathoridism, pancreatic divisive, drug-related pancreatitis due to corticosteroids and smoking accounted for one patient, one case respectively. Out of 30 to 14 patients suffered with edematous pancreatitis, whereas 16 suffered from necrotizing pancreatitis. The views of focal pancreatic enlargement was seen in 86.6% of the cases, whereas peripancreatic fast-standing was seen in 70% of the cases and peripancreatic fluid collection was seen in 50% of the cases. Serious aparyte grade were classified into 2, 4, 6, 8 and 10 according to the modified CT severity score. We further classified the grades into mild, moderate and severe as discussed prior. Out of the total number of necrotized pancreatitis cases, that is 16 patients, 14% had were belong to the severe modified CT severity index grade, whereas 2 belong to the modified CT severity index grade. Extrapancreatic complications were seen in 22% or 22 patients, that is, acytus was seen in 19% relative to pleural effusion in 3, left pleural effusion alone in 5, sphenic weight thrombosis in 7 and pleural venous thrombosis in 1. No mortality was seen in my study. Recommendation, CACT is useful in early stages of acute pancreatitis and it should be supplemented by modified CT severity index to evaluate the severity of the disease to aid further management of patients. As patients with moderate and severe grade of acute pancreatitis have a higher possibility of local complications, a follow-up study with ultrasound or CT may be considered in these patients. The grade of acute pancreatitis was classified as mild, moderate, severe, mild containing grade 2 to 4, moderate containing grade 6 and severe containing grade 8 to 10. Thus, to conclude, idiopathic pancreatitis and alcohol accounts for significant proportion of cases of pancreatitis in adolescent patients. CECD helps in differentiating between endomatis and necrotizing pancreatitis and modified CDC severity index takes into account a variety of factors and helps a proper assessment of pancreatitis. These are the references as listed below. Thank you.