Objective:

To quantify the diagnostic gap between CECT and DSA in hemorrhagic complications of severe acute pancreatitis and evaluate its implications for clinical decision-making, emphasizing the need for timely intervention.

Key Findings:

• Intermodality agreement between CECT and DSA was fair (weighted κ = 0.29), indicating a significant diagnostic gap.
• 69.2% of episodes with negative CECT findings required therapeutic embolization, highlighting the limitations of CECT.
• CECT Grade 2 findings had a high positive predictive value (94.1%) but were associated with all instances of rebleeding, underscoring the need for careful interpretation.

Interpretation:

Negative or non-definitive CECT findings should be interpreted cautiously when clinical suspicion for ongoing hemorrhage persists, as they may lead to missed diagnoses.

Limitations:

• The study is limited to a selected high-risk cohort of SAP patients, which may affect the generalizability of the findings.
• The retrospective design may introduce biases that could impact the results.

Conclusion:

CECT demonstrated limited concordance with angiographic findings, suggesting that angiographic evaluation should be integrated into the diagnostic and therapeutic pathway for high-risk SAP patients to improve outcomes.