CT影像学分级用于急性坏死性胰腺炎病情判别及预后评估的意义

目的：研究急性出血坏死性胰腺炎的ＣＴ分类标准和预后的意义材料与说法方法，搜集急性坏死性胰腺炎３９例，早期均行非手术治疗，均于入院后７２小时内行动态ＣＴ扫描，按ＣＴ影像学表现，将胰腺坏死分为３型，即点片状坏死，段状坏死（坏死部分超过整个胰腺的１／３，坏死范围贯穿胰腺全层）全胰腺坏死（超过胰腺８０％的段状坏死），点片状坏死作为基本记分，坏死部位分为胰头，胰体及胰尾，每一部位计１分；段状坏死３分；全胰腺     

改良CT严重程度指数联合BISAP评分对早期急性胰腺炎预测价值

目的 比较并分析急性胰腺炎(AP)严重程度的三种评分系统即改良CT严重程度指数(MCTSI)评分、急性胰腺炎床边严重程度指数(BISAP)评分及两者联合评分对AP严重程度的预测价值,并对重症急性胰腺炎(SAP)患者治疗的独立危险因素进行探讨.方法 回顾性分析2019年12月至2020年10月在本院确诊为AP的患者79例...     

急性胰腺炎的早期CT诊断和预后评估

目的：探讨ＣＴ对急性胰腺炎的价值及预后评估意义。材料和方法：搜集急性胰腺炎３０例进行回顾性分析,全部病例均作平扫,３例加作增强,检查前不口服造影剂,３０例均按Ｂａｌｔｈａｚａｒ分级,并与临床病情程度及预后进行对照。结果：Ａ级２例,Ｂ级２例,Ｃ级３例,Ｄ级６例,Ｅ例１７例。水肿型者多为Ａ－Ｃ级,出血坏死型者多属Ｅ级,５例有并发症。结论：ＣＴ检查对急性胰腺炎具有较高诊断价值;ＣＴ影象学分级对于急性胰腺     

CT灌注成像对急性重型胰腺炎发生胰腺坏死的早期预测价值

目的 探讨CT灌注成像(CTP)预测急性重型胰腺炎发生胰腺坏死的价值.方法 20例诊断为急性胰腺炎的患者,起病3天之内行CTP,观察有无胰腺缺血.20例胰腺正常的对照组同样行CTP.3周后对20例急性胰腺炎患者复查CT增强扫描观察有无胰腺坏死.结果 对照组CT显示胰腺血流量(PBF)和胰腺血容量(PBV)总是大于肝脏血流量(HBF)和肝脏血容量(HBV) (P ＜0.01).以对照组的扫描结果为标准,当PBF和PBV小于HBF和HBV时,认为存在胰腺缺血(P＜0.01).20例患者中10例存在胰腺缺血.3周后,存在胰腺缺血的10例患者中,有9例发生胰腺坏死;10例未发现胰腺缺血的患者均表现为急性水肿型胰腺炎,未发生胰腺坏死.CTP预测胰腺坏死的敏感度为100％,特异度为90.9％.结论 CTP能早期发现胰腺缺血,预测胰腺坏死,可以作为评价急性重型胰腺炎预后的临床指标.     

CT对急性坏死性胰腺炎的分类与预后评价

根据ＣＴ表现，对１２２例急性坏死性胰腺炎进行了分类并分析与预后的关系。结果：Ⅰ类３１例，无并发症，预后佳；Ⅱ类６０例，Ⅲ类２５例，死亡率分别为１５％和５６％；Ⅳ类６例均死亡。表明ＣＴ表现分类与病情预后有较密切的关系，为临床诊断治疗急性坏死性胰腺炎提供了重要依据。     

急性胰腺炎CT诊断

目的:研究急性胰腺炎的CT征象及诊断价值.材料和方法:对85例急性胰腺炎采取5mm～10mm间隔平扫及增强扫描,对胰周液体聚集者作扩大区域扫描.结果:急性胰腺炎CT表现为不同程度的胰腺肿胀(83/85),胰腺坏死(44/85),胰周积液(46/85),胰腺脓肿(14/85).结论:CT检查在急性胰腺炎的确诊和监测病情的发展等方面有较大实用价值.     

急性胰腺炎CTSI评分与肝／脾CT 值比的相关性分析

目的：探讨急性胰腺炎（acute pancreatitis ,AP）的CTSI评分与肝/脾CT值比（ liver to spleen CT attenuation value ratio ,L/S ）的相关性。方法对87例AP患者进行腹部CT扫描,测量肝脏、脾脏CT值并计算L/S。根据CTSI分级标准由两名放射科医师盲法阅片将A P分为轻度、中度、重度组。分析A P评分分级与L/S之间的关系。结果87例A P患者L/S降低发生率为55％;轻、中、重度A P患者L/S降低发生率分别为23％、53％、88％;轻度、中度、重度A P患者L/S平均值分别为1．07±0．13、0．95±0．20、0．69±0．26。AP的CTSI评分与L/S呈负相关（r ＝-0．451,P ＝0.00）。结论肝/脾CT值比可以反映AP的严重程度,随着AP严重程度的增加,肝损伤的发生率也在增加。     

急性胰腺炎的CT诊断

目的 评价CT在急性胰腺炎诊断中的价值。方法 分析经临床证实的急性胰腺炎43例，全部病例行CT常规扫描及增强扫描。结果 急性胰腺炎表现为单纯胰腺体积的增大18例，体积增大并密度改变16例，体积改变并可见胰腺内坏死或出血9例。结论 对临床疑诊为急性胰腺炎的病例行常规CT检查，结合临床表现可以作出急性胰腺炎的诊断，并可以提示胰腺本身炎症的严重程度及预后估计。     

CT导引下介入治疗胰腺炎

目的：探讨ＣＴ导引下对急性坏死性胰腺炎并发的胰周积液,脓肿或假性囊肿行穿刺、抽吸及注入抗生素治疗的价值。方法：９例急性坏死性胰腺炎均在ＣＴ导引下行胰周积液（４例）、脓肿（３例）、假性囊肿（２例）穿刺、抽吸及注入抗生素治疗,最少治疗２次,最多４次。结果：８例获得较好疗效,１例因这肿与有肠道相通,经４次ＣＴ导引下介入治疗,病情稳定后转外科手术。随访６例,随访时间３￣１８个月,无１例复发。结论：ＣＴ导引     

阑尾炎CT评分在部队急性阑尾炎患者中的应用价值

 目的 探讨阑尾炎CT评分(CTAS)在部队急性阑尾炎(AA)患者中的应用价值。方法 通过参考文献和调查研究制定CTAS系统。调取2018-09至2019-08 35例部队AA患者CT检查资料作为AA组;随机抽取同期35例非阑尾炎(NA)部队官兵腹部CT检查资料作为NA组。回顾性分析两组资料并分别记录其CTAS,了解两组间CTAS差异;根据预测AA的受试者操作特性曲线(ROC曲线)和约登指数(YI)确定最佳截断点,了解CTAS诊断AA的效能。结果 AA组评分均值(5.91±1.90),NA组评分均值(1.51±1.27),组间评分差异有统计学意义(P=0.001)。AA组内不同病理分型评分差异有统计学意义(P=0.001),CTAS越高预示着病变越严重。诊断AA最佳截断点CTAS=3.5(即CTAS≥4时可诊断为AA),敏感性为91.40%,特异性为94.30%,准确率为92.86%。结论 CTAS诊断部队AA患者时,分值≥4分的诊断效能高,有较高临床应用价值。     

胰周渗出的影像表现在急性胰腺炎预后评估中的意义

现有的急性胰腺炎(AP)严重程度评估系统侧重于对胰腺实质的描述,缺少对胰腺和胰周液体聚集改变的临床病理学分析,影响AP严重程度分级和预后判断的准确性。因此,有必要从病理生理学角度来认识AP不同阶段积液的产生和转归,在此基础上,采用超声、CT和MRI等影像技术对胰周积液的性质和变化进行系统分析和归纳比较,有助于临床从全新的影像视角对AP严重程度进行精确的分级和对预后判断。     

CT评价急性重症胰腺炎预后的价值

目的：探讨CT对急性重症胰腺炎病变范围的诊断价值及其与预后的关系。方法：回顾分析42例急性重症胰腺炎患者的病例资料,按胰腺增大、胰周及胰外间隙扩散范围进行CT分级,分析CT分级（Ⅱ～Ⅳ级）与临床Ranson评分标准[R1（0～2分）,R2（3～5分）,R3（〉6分）]及预后因素（死亡人数、手术例数、非手术例数）的相关性。结果：病变范围的CT分级Ⅱ级且临床Ranson评分与R1～R2级者16例,病程相对平稳;同属于Ⅲ～Ⅳ级和R2～R3级者共21例,病程迁延、反复、并发症多,病情危重;介于中间者,同属于CT分级Ⅲ级和R1级者共5例。病变范围的CT分级与临床Ranson评分标准呈正相关（r=0.429,P=0.005）。CT分级Ⅱ级16例均采用非手术治疗;Ⅲ级14例中10例采用非手术治疗,3例手术,1例死亡;Ⅳ级12例中1例采用非手术治疗,7例手术,4例死亡。病变范围CT分级与临床预后间呈正相关（r=0.711,P〈0.001）。结论：病变范围的CT分级对急性重症胰腺炎的临床严重程度和预后评估具有重要的作用,与临床Ranson标准结合更能提高早期预后判断的准确性和可靠性。     

Complications of acute pancreatitis: helical CT evaluation

Acute pancreatitis represents one of the more commonly encountered etiologies of acute abdominal pain. Many complications can present emergently, including pancreatic abscess, necrosis, and hemorrhage. The purpose of this pictorial essay is to educate the reader about the spectrum of CT findings in patients with complications from pancreatitis. Emphasis is placed on evaluation with helical CT, stressing optimal technique and the imaging parameters essential for accurate diagnosis.     

Pancreatic adenocarcinoma: A simple CT score for predicting margin-positive resection in patients with resectable disease

BackgroundNegative-margin status is a prognostic indicator for long-term survival following curative intent resection for pancreatic adenocarcinoma. Patients at increased risk for positive-margin resections may benefit from neoadjuvant chemotherapy prior to resection.MethodsWe retrospectively analyzed preoperative computed-tomography (CT) scans in 108 consecutive patients that underwent curative intent resection for a resectable pancreatic ductal adenocarcinoma from 2009 to 2016 in two academic hospitals. Two radiologists independently staged the tumor, including tumor location, size, and tumor-to-superior mesenteric/portal vein (SMV/PV) contact. Uni and multivariate analysis were performed to identify independent predictors of an R1 resection.ResultsTwenty-nine patients had an R1 resection (26.9%). Tumor size, location, and presence of tumor-to-SMV/PV contact were significantly associated with an R1 resection. In multivariate analysis, the independent parameters associated with resection status were: tumor size (R² = 9.7), and tumor location (neck R² = 6.6; pancreaticoduodenal interface R² = 4.4; uncinate process R² = 4.1), but not tumor-to-SMV/PV contact (R² = 0.1, p = 0.7). A simple CT score was built based on tumor size and location. Patients with an R0 resectability score ≥3, i.e. patients with tumor size ≥30 mm (except when tumor location is at the pancreatico-duodenal interface) or patients with tumor size ≥20 mm AND tumor located in the uncinate process or neck, were at high-risk of an R1 resection (AUC, 0.82; sensitivity, 79%; specificity, 76%). This score also showed good diagnostic performances for predicting an R1 resection involving the medial resection margin only (AUC, 0.85).ConclusionsA simple score based on tumor location and size can accurately predict patients at high-risk of an R1 resection.     

Magnetic resonance imaging versus Acute Physiology And Chronic Healthy Evaluation II score in predicting the severity of acute pancreatitis

Objective

To study the correlation between established magnetic resonance (MR) imaging criteria of disease severity in acute pancreatitis and the Acute Physiology And Chronic Healthy Evaluation II (APACHE II) score, and to assess the utility of each prognostic indicators in acute pancreatitis.

Materials and methods

In this study there were 94 patients with acute pancreatitis (AP), all had abdominal MR imaging. MR findings were categorized into edematous and necrotizing AP and graded according to the MR severity index (MRSI). The APACHE II score was calculated within 24 h of admission, and local complications, death, duration of hospitalization and ICU were recorded. Statistical analysis was performed to determine their correlation.

Results

In patients with pancreatitis, no significant correlation can be found between the APACHE II score and the MRSI score (P = 0.196). The MRSI score correlated well with morbidity (P = 0.006) but not with mortality (P = 0.137). The APACHE II score correlated well with mortality (P = 0.002) but not with the morbidity (P = 0.112). The MRSI score was superior to the APACHE II score as a predictor of the length of hospitalization (r = 0.52 vs. r = 0.35). A high MRSI and APACHE II score correlated with the need for being in the intensive care unit (ICU) (P = 0.000 and P = 0.000, respectively).

Conclusion

In patients with pancreatitis, MRSI is superior to APACHE II in assessing local complications from pancreatitis but has a limited role in determining systemic complications in which the APACHE II score excels.     

99Tcm-环丙沙星显像检测重症急性胰腺炎继发感染的实验研究

目的 用99Tcm标记环丙沙星,评估其生物学特性,并与病理学对照,探讨其在SPECT显像诊断重症急性胰腺炎（SAP）继发感染的价值.方法 制备99Tcm-环丙沙星,测定其标记率和放化纯,并研究其在正常幼猪体内的分布规律.分正常对照组（6头健康幼猪）、非感染组（6头未继发感染的SAP模型幼猪）和感染组（16头SAP继发感染的幼猪）.每头幼猪注射370～400 MBq 99Tcm环丙沙星,分别在给药后0.5,1,2,3,4和6 h行SPECT显像,观察比较不同组别放射性摄取,观察病灶放射性/本底比值随时间变化的规律.并将影像学诊断结果与病理结果对照,评价99Tcm-环丙沙星显像检出SAP继发感染的灵敏度和特异性.组内各时间点变化总体比较采用单因素重复测量的方差分析,组间两两比较及组内各时间点的病灶/本底比值两两比较采用最小显著差异法检验.结果 99Tcm-环丙沙星在6 h内标记率和放化纯均＞90%.静脉注射后药物主要分布在血供丰富的器官,如肾、肝、脾中.胃肠道内无明显摄取,血液清除快,主要经泌尿系统排泄.正常对照组和非感染组胰腺区在6 h内各时段摄取99Tcm-环丙沙星均不明显.感染组在注药后1 h胰腺感染灶开始显影,3 h达高峰,此时感染灶放射性/本底比值为3.36±0.33,明显高于其他时间点,经最小显著差异法检验,F=99.570,P＜0.001,差异有统计学意义.与病理结果对照,99Tcm-环丙沙星显像检测感染灶的灵敏度、特异性、阳性预测值和阴性预测值分别为88.2%（15/17）,5/6,93.8%（15/16）,5/7,约登指数为0.715,Kappa值0.667.结论 99Tcm-环丙沙星放射性分布特点适合胰腺感染灶显像.给药后3 h,SAP继发感染灶摄取明显,为最佳显像时间.用其检测SAP继发感染灶的灵敏度和特异性高,可作为诊断SAP继发感染的手段.