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。     

MRI评价急性胰腺炎严重程度的价值

目的：探讨MRI对急性胰腺炎（AP）严重程度评价的价值。方法：搜集我院经临床诊断为AP并行MRI检查的患者资料,利用APACHEⅡ评分系统对患者进行临床严重程度评分,通过Balthazar分级标准评价MRSI,并分析A-PACHEⅡ评分与MRS I之间的相关性。结果：完全符合纳入排除标准的AP患者共68例。APACHEⅡ评分与MRSI之间的相关系数r=0.286（P〈0.05）,呈弱相关。按照APACHEⅡ评分以8分为标准对AP患者严重程度分组,轻、重两型两组之间的MRSI没有显著性差异（P〉0.05）。而利用MRSI≤3、4~6、≥7将AP疾病严重程度分为轻型、中度、重症三种类型,重症AP组的APACHE评分与轻型AP、中度AP之间有显著性差异（P〈0.05）,轻型AP与中型AP组间APACHE评分差异无显著性（P〉0.05）。结论：相对APACHEⅡ评分系统而言,MRSI更适宜于急性胰腺炎局部并发症严重程度的评价。     

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...     

急性胰腺炎腹膜下间隙扩散程度MR表现与临床严重程度相关性

【摘要】目的:探讨急性胰腺炎(AP) 腹膜下间隙(SPS) 扩散MRI表现与临床严重程度相关性。方法：据急性胰腺炎SPS在CT扩散范围分级拟定将其在MRI扩散范围分为3级。Ⅰ级：网膜受累；Ⅱ级：Ⅰ级基础上出现小肠系膜、横结肠系膜水肿增厚、积液；Ⅲ级：Ⅱ级基础上出现结肠旁沟远处扩散,各级分别记1、2、3分。分析119例AP患者临床及影像资料对其临床急性生理和慢性健康评估Ⅱ、MR严重指数及SPS MR 扩散范围分级进行评估。分析SPS在MRI上扩散范围分级与APACHEⅡ评分及MRSI相关性。结果：据MRSI评分119例AP患者中轻、中、重度AP患者腹膜下间隙受累发生率分别是16/47、63/65及7/7。MRI表现为网膜、系膜及韧带水肿增厚以及小肠、结肠系膜积液、分层同时伴有肠壁水肿及肠腔扩张、积气、积液；腹膜下间隙MR扩散范围分级评分与APACHEⅡ评分呈正相关（r=0.372,P=0.000）；与MRSI评分呈较强正相关（r=0.705,P=0.000）。结论:急性胰腺炎SPS在MRI上扩散范围可反映AP局部并发症也可反映全身并发症是评价AP严重程度一个很好指标。     

影像组学在急性胰腺炎中的应用现状、挑战与展望

影像组学已在急性胰腺炎(AP)的诊断上显示出了明显的优势, 包括预测AP的严重程度、胰腺周围坏死、复发等, 对比传统临床评分与传统临床模型提升了预测效能, 为临床对AP的诊疗提供了更加精准的指导信息。在未来的研究中, 开发基于机器学习的感兴趣区自动勾画软件, 纳入多中心的影像数据, 为提取影像组学特征提供泛化的标准, 将推进机器学习的高速发展;针对临床实际问题, 更加科学地设计研究方案, 是发挥影像组学深层辅助诊断作用的关键所在;建立标准化、结构化、智能化的多维数据来源的胰腺炎专病数据库和多维(组学)模型, 对提高我国对AP的早期预防和精准诊疗水平都有极其重要的意义。     

胰腺炎的影像学诊断(一)

正胰腺炎是非常严重的疾病,不同类型的胰腺炎,其临床及影像学表现也不同,常与其他疾病混淆。现将不同类型胰腺炎介绍如下,以提高对各型胰腺炎的认识及影像诊断水平。1急性胰腺炎(acute pancreatitis,AP)     

急性胰腺炎伴肝损害78例临床分析

目的探讨急性胰腺炎（AP）患者合并肝损害的发病机制、临床特点。方法对128例AP患者的临床资料进行回顾性分析。结果 128例AP中有78例合并肝损害,发生率为60.9%。其中重型急性胰腺炎（SAP）较轻症急性胰腺炎（MAP）肝损害发生率更高,损害程度更明显,差异均具有统计学意义（P〈0.05）。结论 AP大多伴有肝损害,其损害程度可反映急性胰腺炎严重程度,并与其病程有关。     

急性胰腺炎相关性肺损伤的CT表现

目的 探讨急性胰腺炎(AP)相关性肺损伤(APALI)的CT表现.资料与方法 102例AP患者根据亚特兰大临床分类标准分为轻症急性胰腺炎(MAP)和重症急性胰腺炎(SAP),分析APALI的发生情况及CT表现,并进行CT形态学分级评分,分析APALI的CT形态学分级评分与AP严重程度临床分级评分的相关性.结果 102例AP共发生APALI 71例,其中MAP 41例,SAP 30例.APALI的CT表现包括:33例CT表现为胸腔积液、积血,胸膜增厚;18例出现肺内条索状或网格状影;20例出现肺内磨玻璃状模糊影或斑片状实变影;APALI的CT形态学分级评分与AP严重程度临床分级评分呈正相关(r=0.314,P＜0.05).结论 APALI的CT表现为胸腔积液、积血,胸膜增厚;肺内条索状或网格状影;肺内磨玻璃状模糊影或斑片状实变影;CT形态学分级评分与AP严重程度临床分级评分具有一定的相关性,可作为判断AP病情严重程度的影像学参考依据.     

Multiple MRI score systems versus Acute Physiology,Age and Chronic Healthy Evaluation Ⅱ score in predicting the severity of acute pancreatitis:a ROC analysis

目的：评价多种磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度的准确性。方法：临床确诊161例急性胰腺炎患者接受 MRI 检查（其中平扫86例,平扫＋增强75例）,对75例急性胰腺炎 MRI 增强患者,五种磁共振评分系统（Balthazar 分级、磁共振严重指数、修正磁共振严重指数、胰外炎症磁共振评分、肠系膜水肿与腹膜腔积液评分）对其严重程度进行评价,对所有161例急性胰腺炎患者,三种磁共振评分系统（Balthazar 分级、胰外炎症磁共振评分、肠系膜水肿与腹膜腔积液评分）对其严重程度进行评价。利用 ROC 曲线比较分析磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度的准确性。结果：161例急性胰腺炎患者,25例（15．5％）临床上确诊为重度急性胰腺炎,6例（3．7％）死亡。磁共振严重指数、胰外炎症磁共振评分预测急性胰腺炎严重程度及死亡具有较高的准确性,但磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度无显著差异（P ＞0．05）。结论：与急性生理、年龄、慢性健康评分系统Ⅱ比较,磁共振评分系统预测急性胰腺炎严重程度没有优势,急性胰腺炎入院接受 MRI 检查评价严重程度不被推荐。     

急性胰腺炎伴发胸腔积液的MDCT表现及解剖基础

目的：研究急性胰腺炎（AP）向纵隔扩散并致胸腔积液（PE）的 CT 表现、解剖通道,以及与急性胰腺炎 CT 严重指数（CTSI）和急性生理慢性健康评分系统Ⅱ（APACHEⅡ）的相关性。方法：回顾分析119例因 AP 入院并行 CT 检查患者。观察 PE 发生率、胰周积液向纵隔扩散的解剖途径并评分分级;AP 的严重程度用 CTSI 及 APACHEⅡ评分分级并统计分析 PE 分级与 CTSI 及 APACHEⅡ评分相关性。结果：119例74．78％患者并发不同程度 PE。胰周积液向纵隔扩散时食管裂孔受累25．21％,主动脉裂孔5．04％,下腔静脉裂孔2．52％。PE 评分与 CTSI 正相关（r＝0．449,P ＜0．01）,与APACHE Ⅱ评分无相关性（r＝0．197,P ＜0．05）。结论：AP 伴发 PE 较常见,胰周积液通过膈肌裂孔向胸腔扩散。PE 也可以做为评价 AP 严重程度的辅助指标。     

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。     

MR imaging of acute pancreatitis: Correlation of abdominal wall edema with severity scores

Objective

To study MRI findings of abdominal wall edema (AWE) in acute pancreatitis as well as correlations between AWE and the severity of acute pancreatitis according to the MR severity index (MRSI) and the Acute Physiology And Chronic Healthy Evaluation III (APACHE III) scoring system.

Materials and methods

A total of 160 patients with AP admitted to our institution between December 2009 and March 2011 were included in this study. MRI was performed within 48 h after admission. MRI findings of acute pancreatitis were noted, including AWE on the MRI. The abdominal wall area was divided into quarters, and each area involved was recorded as 1 point to score the severity of AWE. The severity of acute pancreatitis was studied using both the MRSI and the APACHE III scoring system. Spearman correlation of AWE with the MRSI and the APACHE III scoring system was analyzed.

Results

In 160 patients with acute pancreatitis, 53.8% had AWE on MRI. The average AWE score was 1.2 ± 1.4 points. The prevalence of AWE was 30.5%, 64.5% and 100% in mild, moderate and severe AP, respectively, according to MRSI. AWE on MRI was correlated with MRSI scores (r = 0.441, p = 0.000). According to APACHE III scores, the averages were 2.0 ± 1.1 and 2.6 ± 1.1 points in mild AP and severe AP, respectively (P = 0.016). AWE was slightly correlated with the APACHE III scores (r = 0.222, p = 0.005).

Conclusion

AWE on MRI in acute pancreatitis is common, which may be a supplementary indicator in determining the severity of AP.     

急性胰腺炎的并发症:胰周血管疾病的MRI表现

目的探讨急性胰腺炎(AP)并发各类胰周血管疾病的MRI表现。资料与方法回顾性分析本院2009年6月至2010年9月期间122例AP患者资料,男73例,女49例,平均年龄(45±16)岁。所有病例均签署知情同意书。采用GE1.5TMR扫描:梯度回波T1加权,快速恢复快速自旋回波T2加权,单次激发快速自旋回波T2加权,MR胰胆管成像,动态增强扫描。观察:(1)动脉侵犯/动脉炎;(2)假性动脉瘤;(3)静脉炎、静脉血栓形成/静脉栓塞;(4)胰源性门静脉高压症/门静脉海绵样变。结果本组AP并发胰周血管病变的发生率为17.2%(21/122)。21例AP并发胰周血管病变患者中,动脉侵犯/动脉炎占16/21(脾动脉、肝总动脉、肠系膜上动脉、腹腔干受累率分别为16/16、13/16、12/16、7/16)。脾动脉假性动脉瘤占1/21。静脉炎占19/21(脾静脉、门静脉、肠系膜上静脉受累率分别为19/19、13/19、9/19),静脉血栓形成/静脉栓塞占2/21(1例脾静脉部分性栓塞,另1例门静脉、脾静脉、肠系膜上静脉广泛性栓塞)。胰源性门静脉高压症/门静脉海绵样变占2/21。结论 AP能并发多种胰周血管病变,每种血管病变都...     

Imaging acute pancreatitis

Acute pancreatitis is a common condition (thought to be increasing in incidence worldwide), which has a highly variable clinical course. The radiologist plays a key role in the management of such patients, from diagnosis and staging to identification and treatment of complications, as well as in determining the underlying aetiology. The aim of this article is (i) to familiarise the reader with the pathophysiology of acute pancreatitis, the appearances of the various stages of pancreatitis, the evidence for the use of staging classifications and the associated complications and (ii) to review current thoughts on optimising therapy.The International Symposium on Acute Pancreatitis (AP) in Atlanta defined AP as inflammation of the pancreas with variable secondary involvement of remote organs [1]. The incidence ranges from 5 to 80 per 100 000, with the highest incidence occurring in the USA and Finland [2]. In the UK, the incidence of AP requiring hospital admission has doubled in the past three decades, from 4.9 per 100 000 (1963–1974) to 9.8 per 100 000 (1987–1998) [3]. The severity of AP is highly variable; it can range from mild and self-limiting to fulminant. The latter occurs in 20–30% of all cases of AP and is associated with a protracted clinical course, often complicated by sepsis, multiorgan failure and a mortality rate of up to 50% [1]. It is widely accepted that these two subgroups are separate entities; mild pancreatitis (also known as oedematous AP) rarely progresses to the fulminant necrotising subtype. Clearly, the prognosis and management for these two subgroups of AP are very different. In mild oedematous AP, management is primarily supportive, whereas necrotising AP usually requires care in an intensive unit setting with a combination of surgical and radiological interventions.The commonest aetiological factors for AP are cholelithiasis and alcohol; the former is more prevalent in southern Europe, whereas alcohol-induced pancreatitis is more common in northern Europe. Alcohol is also known to be associated with a higher incidence of acute fulminant pancreatitis [4]. Other less common causes for AP include iatrogenic causes such as endoscopic retrograde cholangiopancreatography (ERCP), abdominal surgery, trauma, congenital pancreatic divisum, hyperlipidaemia, hypercalcaemia and various infections.The initial diagnosis for AP is made clinically from signs and symptoms of an acute abdomen and an elevation of pancreatic enzymes, such as amylase and lipase, in the blood or urine. Once the diagnosis is confirmed, it is usually evident clinically within the first 48–72 h as to whether the condition will be mild or fulminant [5]. Mild pancreatitis is characterised by minimal or absent systemic organ dysfunction and tends to abate by the third day. In contrast, fulminant pancreatitis demonstrates progressive clinical symptoms and signs with associated metabolic and multiorgan dysfunction. Since the 1980s, many clinical scoring systems, such as Ranson''s criteria [6] and the APACHE II (Acute Physiology and Chronic Health Evaluation) score [7], have been used to provide an objective assessment of the severity of pancreatitis.     

Acute pancreatitis: the role of imaging in diagnosis and management

Acute pancreatitis is one of the more commonly encountered aetiologies in the emergency setting and its incidence is rising. Presentations range from a mild-self limiting condition which usually responds to conservative management to one with significant morbidity and mortality in its most severe forms. While clinical criteria are necessary to make the initial diagnosis, contrast-enhanced CT is the mainstay of imaging and has a vital role in assessing the extent and evolution of the disease and its associated complications. The purpose of this article is to summarise the natural course of acute severe pancreatitis, clarify confusing nomenclature, demonstrate the morphological stages in conjunction with radiological scoring systems and illustrate the complications. We will review and illustrate the increasing and significant role interventional radiology has in the management of these patients, which are often life-saving and surgery-sparing.     

影像组学和基因组学在急性胰腺炎中的应用进展

对急性胰腺炎（AP）的严重程度、发展趋势做出准确、及时的判断,并根据其潜在的病理机制给予及时、个性化的治疗和干预是临床亟待解决的问题。通过影像组学和基因组学结合来提高对AP的诊断能力并提供预测其发展的生物标志物是当今临床研究的新方向。影像组学可以挖掘医学影像中肉眼不能识别的数据,从而预测AP的严重程度、并发症、复发及胰周坏死;基因组学则能用于分析AP的基因背景,有助于研究AP的分子机制。就影像组学和基因组学在AP中的应用研究进展进行综述。     

Detection of severe acute pancreatitis by contrast-enhanced magnetic resonance imaging

The aim of the study was to assess the ability of MRI to differentiate between the two forms of severity of acute pancreatitis (AP), which is important for the detection of patients who require intensive monitoring and therapy. The second objective was to evaluate whether the distinction would be possible regardless of the MRI equipment. Magnetic resonance imaging was performed before and after intravenous administration of a gadolinium (Gd) chelate at 1.0 T using the breath-hold multislice rapid gradient-echo turbo fast low-angle shot (FLASH) sequence in 14 patients, and at 1.5 T with the 2D FLASH(50) sequence with fat saturation in 18 patients with acute pancreatitis early in the course of the disease. The patients were classified according to the Atlanta classification system as having the mild (MAP) or severe (SAP) form of the disease. At 1.0 T with use of a body coil, contrast-enhanced MRI failed to distinguish mild from severe pancreatitis. At 1.5 T with a phased-array body coil, the signal intensities of the patients with SAP were statistically significantly lower than those of the MAP group. Our initial clinical experience suggests that MRI with a sufficient magnetic field gradient strength may be useful for separating the two forms of acute pancreatitis in their early phases. Received: 19 January 1999; Revised: 28 May 1999; Accepted: 22 July 1999     

Acute Pancreatitis: The Role of Imaging and Interventional Radiology

Acute pancreatitis can manifest as a benign condition with minimal abdominal pain and hyperamylasemia or can have a fulminant course, which can be life-threatening usually due to the development of infected pancreatic necrosis, and multisystem organ failure [1, 2]. Fortunately, 70–80% of patients with acute pancreatitis have a benign self-limiting course (Figs. 1, 2, 4). The initial 24-48 hours after the initial diagnosis is usually the period that determines the subsequent course, and for many of the 20–30% of patients who subsequently have a fulminant course, this becomes apparent within this time frame. With reference to long-term outcome following acute pancreatitis, most cases recover without long-term sequelae with only a minority of cases progressing to chronic pancreatitis [5]. In the initial management of acute pancreatitis, assessment of metabolic disturbances and systemic organ dysfunction is critical. However, the advent and continued refinement of cross-sectional imaging modalities over the past two decades has led to a prominent role for diagnostic imaging in assessing acute pancreatitis. Furthermore, these cross-sectional imaging modalities have enabled the development of diagnostic and therapeutic interventional techniques in the hands of radiologists. In this article we review the diagnostic features of acute pancreatitis, the clinical staging systems, complications and the role of imaging. The role of interventional radiology techniques in the management of acute pancreatitis will be discussed as well as potential complications associated with these treatments.     

640层动态容积CT心电门控技术评估急性胰腺炎脾动脉血管壁弹性变化

目的应用640层动态容积CT(DVCT)心电门控技术获得急性胰腺炎(AP)脾动脉血管壁弹性度(D)的变化规律,探讨其与改良CT严重度指数(MCTSI)、床旁严重指数(BISAP)的相关性。资料与方法采用640层DVCT前瞻性心电门控技术对40例AP组和21例非AP组受试者进行胰腺增强扫描,获得1个心动周期内脾动脉轴位面积的最大值及最小值,并计算D值。采用受试者工作特征(ROC)曲线评价D值对AP的诊断效能。由MCTSI、BISAP两项指数对AP组的严重程度进行评分,分析其与AP组D值的相关性。结果AP组与非AP组D值分别为(6.09±1.83)×10^-3/mmHg、(8.32±1.05)×10^-3/mmHg,差异有统计学意义(P<0.01)。根据MCTSI评分分级,AP组不同严重程度亚组间D值比较,差异有统计学意义(P<0.05),且中、重度与非AP组D值差异有统计学异意义(P均<0.05)。D值对诊断AP的ROC曲线下面积为0.865,最佳临界值为7.31×10^-3/mmHg,敏感度及特异度分别为80.0%和85.7%。AP组的两项指数与D值均呈负相关(r=-0.937、-0.658,P均<0.001)。结论640层DVCT前瞻性心电门控扫描技术对D值的定量分析可能是对AP的一种影像量化标记,D值的变化表明了AP的严重程度。