急性胰腺炎患者坏死性积聚的CT和MRI特征及转归分析

闫威; 董力宁; 张斌斌; 杨大为; 杨正汉; 王振常; 靳二虎

doi:10.15953/j.ctta.2022.141

急性胰腺炎患者坏死性积聚的CT和MRI特征及转归分析

doi: 10.15953/j.ctta.2022.141

1.
首都医科大学附属北京友谊医院放射科, 北京100050
2.
首都医科大学附属北京中医医院放射科, 北京100010

基金项目: 北京市医院管理中心临床医学发展专项（定量影像研究（ZYLX202101））。

详细信息

作者简介:
闫威：女，首都医科大学附属北京友谊医院放射科在职硕士研究生，研究方向为腹部疾病影像诊断，E-mail：yw285858404@sina.com

靳二虎：男，医学博士，首都医科大学附属北京友谊医院放射科主任医师、教授、博士研究生导师，长期从事医学影像诊断相关的临床、教学和科研工作，专业特长是腹盆部疾病影像诊断，E-mail：erhujin@263.net

通讯作者:
靳二虎*，

中图分类号: R 814；R 445
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- 被引次数: 0
出版历程
- 收稿日期: 2022-06-19
- 修回日期: 2022-08-14
- 录用日期: 2022-08-25
- 网络出版日期: 2022-09-02
- 刊出日期: 2023-01-31

CT and MRI Features and Prognosis of Acute Necrotic Collectionsin Patients with Acute Pancreatitis

1.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
2.
Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China

摘要

摘要: 目的：总结急性坏死性胰腺炎（ANP）患者局部并发症急性坏死性积聚（ANC）的影像特征，探讨影响ANC转归的因素。方法：回顾性分析31例ANP患者的临床及影像资料，在CT或MRI上观察ANC的影像特点，将其转归分为吸收组与包裹性坏死（WON）组，采用卡方检验比较两组间差异的统计学意义。结果：31例ANC平扫CT均呈斑片状不均匀低密度影，其内见小灶性类圆形等、低密度混杂影（23例）及脂肪低密度影（22例）；19例ANC在平扫MRI均呈T1混杂低信号、T2混杂较高信号，其内FS T2WI可见低信号碎片影。3例（9.7％）合并局部感染，12例（38.7％）合并出血。增强扫描坏死组织无强化，其周边可有不同程度的斑片状或线样强化。对31例ANP患者随访（中位137天）显示，12例（38.7％）ANC完全吸收，19例（61.3％）形成WON，吸收组与WON组在坏死是否累及胰腺、累及胰腺部位、坏死体积、MCTSI评分的差异有统计学意义。结论：ANC在CT表现为不均匀液体密度，MRI呈不均匀信号影，增强扫描坏死组织无强化，但其周边组织可有不同程度强化改变。随访显示ANC可完全吸收或形成WON，并与多个影像因素相关。
- 改良计算机体层摄影严重指数 /
- 胰腺炎 /
- 急性坏死性积聚
Abstract: Objective: To summarize the imaging features of acute necrotic collections (ANC), a local complication of acute necrotizing pancreatitis (ANP), and to explore the factors affecting the prognosis of patients with ANC. Methods: The clinical and imaging data of 31 patients with ANP were analyzed retrospectively. Characteristics of ANC on computed tomography (CT) and magnetic resonance imaging (MRI) were analyzed as well. Based on the follow-up outcomes, patients were divided into the absorption group and the walled-off necrosis (WON) group; a chi-square test was used to compare the two. Results: Plain CT revealed patchy, uneven, low-density shadows in 31 cases of ANC (focal, oval, and iso-density and low-density mixed shadows:23 cases; fatty low-density shadows: 22 cases). Plain MRI revealed mixed low-signal intensities on T1-weighted imaging and mixed high-signal intensities on T2-weighted imaging in 19 cases of ANC; low-signal fragments were seen on Fat suppressed T2-weighted imaging in some of these cases. ANC was complicated with local infection and hemorrhage in 3 (9.7%) and 12 (38.7%) cases, respectively. The necrotic tissues did not show any enhancement, but the surrounding tissues appeared patchy or linear-enhancing changes with varying degrees on enhanced scans. Follow-up examination (median: 137 days) revealed that ANC was completely absorbed in 12 cases (38.7%) and had developed into WON in 19 cases (61.3%). The absorption and WON groups differed significantly in terms of necrosis involving the pancreas, affected locations of the pancreas, necrotic volumes, and the modified CT severity index scores. Conclusion: On CT and MRI, ANC appears as uneven liquid densities and heterogeneous signal intensities, respectively. The necrotic tissue itself has no enhancement, but its surrounding tissue presents with different degrees of enhancing changes on enhanced scanning. Follow-up findings reveal that ANC can completely dissipate or progress to WON, which is related to several imaging factors.
- improved computed tomography severity index /
- pancreatitis /
- acute necrotic collection

HTML全文

图 1 男性，26岁，急性坏死性胰腺炎

发病后第5天轴面增强CT动脉期显示ANC分布于左侧肾旁前间隙（箭）。

Figure 1. Male, 26 years old; acute necro-tizing pancreatitis

下载: 全尺寸图片幻灯片

图 2 女性，31岁，急性坏死性胰腺炎

（a）～（c）发病后第5天增强CT检查，（a）轴面平扫CT显示胰周地图样液体积聚，其内见小灶性低密度脂肪碎片（箭）；轴面增强CT动脉期（b）及静脉期（c）示胰腺实质大部坏死，未见强化（箭）。（d）发病后第43天增强CT动脉期显示病变内多发气体影（箭），提示WON合并感染，病变周边囊壁异常强化。

Figure 2. Female, 31 years old; acute necrotizing pancreatitis

下载: 全尺寸图片幻灯片

图 3 女性，35岁，急性坏死性胰腺炎

发病后第5天MRI检查，（a）轴面脂肪抑制FSE T2WI显示胰周ANC内多发小结节状低信号灶（箭），提示脂肪碎片或坏死脂肪组织；（b）轴面脂肪抑制FSPGR T1WI示胰周液体信号不均匀（箭），其中胰尾周围片状较高信号提示出血。

Figure 3. Female, 35 years old; acute necrotizing pancreatitis

下载: 全尺寸图片幻灯片

图 4 男性，75岁，急性坏死性胰腺炎

（a）发病后第2天，轴面增强CT动脉期显示ANC的边界游离，无异常强化（箭）；（b）发病后第13天，轴面增强CT动脉期显示ANC的囊壁不连续，可见异常强化（箭）；（c）发病后第73天，MRI检查轴面增强T1WI静脉期显示WON的囊壁连续且清晰，可见异常强化（箭）。

Figure 4. Male, 75 years old; acute necrotizing pancreatitis

下载: 全尺寸图片幻灯片

表 1 31例ANP患者ANC转归的影响因素

Table 1. Factors influencing the ANC outcome in 31 patients with ANP

项目	影响因素	WON组（n=19）	吸收组（n=12）	P
坏死是否累及胰腺	累及胰腺及胰周	19	7	0.005
坏死是否累及胰腺	仅累及胰周组织	0	5	0.005
胰腺坏死部位	胰头	9	0	0.005
	胰体	18	5	0.002
	胰尾	14	5	0.060
	两个部位及以上	17	2	0.000
坏死体积	<30％	5	10	0.003
坏死体积	≥30％	14	2	0.003
是否合并感染	合并感染	1	2	0.543
是否合并感染	未合并感染	18	10	0.543
是否伴有出血	有出血	9	3	0.274
是否伴有出血	无出血	10	9	0.274
MCTSI评分	≤6分	2	9	0.000
MCTSI评分	＞6分	17	3	0.000
病因	胆石症	10	7	1.000
	酗酒	2	1	1.000
	高脂血症	10	2	0.065

下载: 导出CSV

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