Diagnostic Accuracy of Ultrasonography in Diagnosing Acute Pancreatitis, Taking Computed Tomography (CT) as a Gold Standard

Abstract

Background: Acute pancreatitis is a leading gastrointestinal emergency with substantial morbidity, particularly in resource-limited settings where access to contrast-enhanced computed tomography (CT)—the gold standard for diagnosis—is often restricted. Despite ultrasonography being more accessible and radiation-free, its diagnostic accuracy compared to CT in such settings remains insufficiently validated. Objective: This study aimed to evaluate the diagnostic accuracy of ultrasonography for acute pancreatitis, using contrast-enhanced CT as the reference standard, and to assess its potential as a first-line imaging modality in regions with limited CT access. Methods: In this prospective, cross-sectional diagnostic accuracy study, 81 adult patients (aged 18–70) presenting with clinical features and laboratory evidence of acute pancreatitis at a tertiary care hospital in Pakistan were enrolled. Exclusion criteria included chronic pancreatitis, prior pancreatic surgery, pregnancy, or contrast allergy. All participants underwent ultrasonography and CT within 24 hours. Sensitivity, specificity, predictive values, and area under the receiver operating characteristic curve (AUC) were calculated using SPSS v27. Ethical approval was obtained from the institutional review board (IRB Approval No: RAD-2022-012-3673) in accordance with the Helsinki Declaration. Results: Ultrasonography demonstrated a diagnostic accuracy of 86.42%, with sensitivity of 88.24%, specificity of 83.33%, positive predictive value of 90.00%, and negative predictive value of 80.65%. The AUC was 0.85, indicating strong discriminatory capacity. Ultrasonography reliably identified acute pancreatitis in the majority of cases, with minimal operator-dependent variability. Conclusion: Ultrasonography provides high diagnostic accuracy for acute pancreatitis and can serve as a practical first-line imaging tool in resource-limited healthcare settings, enabling earlier diagnosis and intervention while minimizing radiation exposure and healthcare costs.