Variant: 1
Suspected acute pancreatitis. First time presentation. Epigastric pain and increased amylase and lipase. Less than 48 to 72 hours after symptom onset. Initial imaging.
| Procedure | Appropriateness Category |
| US abdomen | Usually Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without and with IV contrast with MRCP | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis with IV contrast | May Be Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate |
Variant: 2
Suspected acute pancreatitis. Initial presentation with atypical signs and symptoms; including equivocal amylase and lipase values (possibly confounded by acute kidney injury or chronic kidney disease) and when diagnoses other than pancreatitis may be possible (bowel perforation, bowel ischemia, etc.). Initial imaging.
| Procedure | Appropriateness Category |
| MRI abdomen without and with IV contrast with MRCP | Usually Appropriate |
| CT abdomen and pelvis with IV contrast | Usually Appropriate |
| US abdomen | May Be Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis without IV contrast | May Be Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate |
Variant: 3
Acute pancreatitis. Critically ill, systemic inflammatory response syndrome (SIRS), severe clinical scores (eg, Acute Physiology, Age, and Chronic Health Evaluation [APACHE]-II, Bedside Index for Severity in AP [BISAP], or Marshall). Greater than 48 to 72 hours after onset of symptoms.
| Procedure | Appropriateness Category |
| MRI abdomen without and with IV contrast with MRCP | Usually Appropriate |
| CT abdomen and pelvis with IV contrast | Usually Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis without IV contrast | May Be Appropriate |
| US abdomen | Usually Not Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate |
Variant: 4
Acute pancreatitis. Continued SIRS, severe clinical scores, leukocytosis, and fever. Greater than 7 to 21 days after onset of symptoms.
| Procedure | Appropriateness Category |
| MRI abdomen without and with IV contrast with MRCP | Usually Appropriate |
| CT abdomen and pelvis with IV contrast | Usually Appropriate |
| US abdomen | May Be Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis without IV contrast | May Be Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate |
Variant: 5
Known necrotizing pancreatitis. Significant deterioration in clinical status, including abrupt decrease in hemoglobin or hematocrit, hypotension, tachycardia, tachypnea, abrupt change in fever curve, or increase in white blood cells.
| Procedure | Appropriateness Category |
| CT abdomen and pelvis with IV contrast | Usually Appropriate |
| US abdomen | May Be Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without and with IV contrast with MRCP | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis without IV contrast | May Be Appropriate |
| CT abdomen and pelvis without and with IV contrast | May Be Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
Variant: 6
Acute pancreatitis. Known pancreatic or peripancreatic fluid collections with continued abdominal pain, early satiety, nausea, vomiting, or signs of infection. Greater than 4 weeks after symptom onset.
| Procedure | Appropriateness Category |
| MRI abdomen without and with IV contrast with MRCP | Usually Appropriate |
| CT abdomen and pelvis with IV contrast | Usually Appropriate |
| US abdomen | May Be Appropriate |
| US duplex Doppler abdomen | May Be Appropriate |
| MRI abdomen without IV contrast with MRCP | May Be Appropriate |
| CT abdomen and pelvis without IV contrast | May Be Appropriate |
| US abdomen with IV contrast | Usually Not Appropriate |
| CT abdomen and pelvis without and with IV contrast | Usually Not Appropriate |