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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

闫威, 董力宁, 张斌斌, 等. 急性胰腺炎患者坏死性积聚的CT和MRI特征及转归分析[J]. CT理论与应用研究, 2023, 32(1): 113-120. DOI: 10.15953/j.ctta.2022.141
引用本文: 闫威, 董力宁, 张斌斌, 等. 急性胰腺炎患者坏死性积聚的CT和MRI特征及转归分析[J]. CT理论与应用研究, 2023, 32(1): 113-120. DOI: 10.15953/j.ctta.2022.141
YAN W, DONG L N, ZHANG B B, et al. CT and MRI Features and Prognosis of Acute Necrotic Collectionsin Patients with Acute Pancreatitis[J]. CT Theory and Applications, 2023, 32(1): 113-120. DOI: 10.15953/j.ctta.2022.141. (in Chinese)
Citation: YAN W, DONG L N, ZHANG B B, et al. CT and MRI Features and Prognosis of Acute Necrotic Collectionsin Patients with Acute Pancreatitis[J]. CT Theory and Applications, 2023, 32(1): 113-120. DOI: 10.15953/j.ctta.2022.141. (in Chinese)

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
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

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

  • 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。

     

  • 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

    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

    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

    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

    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1970.005
       仅累及胰周组织 05
        胰腺坏死部位   胰头 900.005
       胰体1850.002
       胰尾1450.060
       两个部位及以上1720.000
        坏死体积   <30% 510 0.003
       ≥30%142
        是否合并感染   合并感染120.543
       未合并感染1810
        是否伴有出血   有出血 930.274
       无出血109
        MCTSI评分   ≤6分 290.000
       >6分173
        病因   胆石症1071.000
       酗酒 211.000
       高脂血症1020.065
    下载: 导出CSV
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  • 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

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