螺旋CT对急性胰腺炎诊断的应用价值

目的:探讨螺旋CT在急性胰腺炎诊断中的应用价值。方法:回顾分析60例经临床确诊急性胰腺炎病例的CT影像学改变。结果:临床诊断水肿型胰腺炎52例;急性坏死型胰腺炎8例。CT检查表现为胰腺肿大46例,密度改变8例,胰周积液35例,并发假性囊肿5例,并发蜂窝织炎16例,并发脓肿2例,合并少量胸腔积液18例,两下肺炎症22例等影像学改变。结论:螺旋CT是诊断急性胰腺炎简便而有效的影像学检查方法,对指导临床正确诊断及制订治疗方案具有重要意义。     

CT检查对急性胰腺炎早期诊断的价值

目的：探讨急性胰腺炎的CT征象、分级与临床分型、预后的关系以及CT对急性胰腺炎早期诊断的价值。方法：对67例手术病理或临床检查证实急性胰腺炎的CT资料进行回顾性分析。结果：CT表现胰腺肿胀49例，胰腺渗液38例，胰腺坏死18例，假性囊肿形成11例，合并感染或脓肿形成8例。结论：CT对急性胰腺炎的诊断正确率为95．5％明显高于B超的55.2％，同时不仅能明确诊断而且有助临床定量、发现并发症和判断预后，应作为诊断急性胰腺炎的首选方法。     

螺旋CT对急性胰腺炎的诊断价值

目的：探讨螺旋CT对急性胰腺炎的诊断价值，进一步提高急性胰腺炎的诊断水平。方法：回顾分析59例急性胰腺炎病例的螺旋CT资料。结果：急性胰隙炎主要表现为胰腺肿胀、胰腺密度减低、胰腺包膜增厚、胰外急性积液、蜂窝组织炎、假囊肿、脓肿以及其它合并症。结论：螺旋CT可以早期确诊急性胰腺炎，发现病因和诊断并发症，为临床确定治疗方案提供依据．     

螺旋CT对急性胰腺炎的诊断价值

目的评价螺旋CT对急性胰腺炎的诊断价值。方法对经临床及手术明确诊断的56例急性胰腺炎CT表现进行分析。结果急性水肿型胰腺炎53例,急性坏死型胰腺炎3例;CT表现为胰腺弥漫性或局限性增大,胰周脂肪间隙模糊、胰周渗液、肾筋膜增厚。胰腺内低密度灶20例,假性囊肿形成6例,胆道结石28例。53例急性水肿型胰腺炎和1例坏死型胰腺炎保守治疗痊愈,2例坏死型胰腺炎手术治疗痊愈。25例合并胆道结石者行腹腔镜手术。结论螺旋CT诊断急性胰腺炎及其并发症是最有效的方法,而且对急性胰腺炎的临床治疗有着重要的指导意义。     

重症急性胰腺炎的增强CT及MRI特征

重症急性胰腺炎常引起胰腺实质及胰周组织的损坏，并伴有休克，弥漫性血管内凝血，严重代谢及多脏器衰竭，还可出现胰腺坏死，脓肿，假性囊肿，瘘管及假性动脉瘤等局部并发症，增强CT及MRI在区别正常胰腺与胰腺坏死，判断胰周炎性病变及液体聚积作用方面相似，MRI的多平面成像，可判断液体聚积，假性囊肿与上腹部结构的关系。MRI发现出血，瘘管，周围脏器炎症较CT敏感，而发现气泡，钙化，假性动脉瘤CT优于MRI。     

重症急性胰腺炎的增强CT及MRI特征

重症急性胰腺炎常引起胰腺实质及胰周组织的损坏，并伴有休克、弥漫性血管内凝血、严重代谢紊乱及多脏器衰竭，还可出现胰腺坏死、脓肿、假性囊肿、瘘管及假性动脉瘤等局部并发症。增强CT及MRI在区别正常胰腺与胰腺坏死、判断胰周炎性病变及液体聚积作用方面相似。MRI的多平面成像，可判断液体聚积、假性囊肿与上腹部结构的关系。MRI发现出血、瘘管、周围脏器炎症较CT敏感，而发现气泡、钙化、假性动脉瘤CT优于MRI。     

急性胰腺炎156例的CT分析及临床意义

目的:探讨急性胰腺炎病人胰腺实质和胰外相关CT征象。方法:对经手术和临床证实的156例急性胰腺炎病人的CT征象进行回顾性分析。结果:156例中急性水肿性胰腺炎91例(58.3%),出血坏死性65例(41.7%)。CT发现胰腺肿胀115例;胰实质出血21例,坏死31例,胰腺脓肿15例。有胰周、胰外符合并症进106例(67.9%),其中胰周水肿76例,胰周积液27例,胰周峰窝织炎32例,胰周脓肿18例,胰内或胰周假性囊肿12例;前肾旁间隙积液56例;胆系结石83例,胆囊炎症41例,肝脂肪浸润26例;腹水42例;胸水96例,下肺炎症17例,心包积液9例,ARDS 7例。本组手术治疗29例,非手术治疗127例。治愈和好转148例,死亡8例(5.1%)。结论:CT检查有助于发现急性胰腺炎的胰实质、胰周和胰外相关病变,对本病的定性诊断、分型、治疗选择和预后评估有重要价值。     

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     

胰腺炎并发假性囊肿或积液的CT分型与命名

目的：探讨胰腺炎并发假性囊肿或积液的CT分型与命名，为其诊断及鉴别诊断提供依据。方法：分析我院收治的胰腺炎合并假性囊肿或积液40例的CT影像学特征、发病机制及病理特点，并根据以上特征进行临床分型与命名。结果：以胰腺为主体，由近至远对胰腺炎并发假性囊肿或积液进行分型和命名，可分为胰内型、胰周型、胰内伴胰周型、异位型、胰内伴异位型、胰周伴异位型和胰内胰周伴异位型等7种类型。结论：分型与命名既能反映病源性质，又能确切地反映病变受累范围及CT扫描的特征，有利于诊断及制定有效治疗措施和选择手术时机及方式。     

急性出血坏死性胰腺炎CT动态复查的价值

目的　探讨CT动态复查扫描对急性出血坏死性胰腺炎诊治的价值。方法　对 2 1例经手术病理及临床CT复查确诊的急性出血坏死性胰腺炎的资料进行回顾性分析。全部病例均做平扫与增强扫描 ,胰腺区域采用薄层扫描方法。结果　CT显示胰腺点片状坏死 12例 ,片段状坏死 8例 ,全胰坏死 1例。其中 3例首次CT为急性水肿型胰腺炎 ,2 4～ 72h动态复查显示为点片状及段状坏死。 4例在治疗过程中发现胰周脓肿 ,12例在后期复查时发现胰内外假囊肿。结论　CT动态复查对急性出血坏死性胰腺炎定性、分级诊断与合理治疗有重要价值     

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.     

Acute pancreatitis and its complications. Computed tomography and sonography

Acute pancreatitis is a clinical diagnosis. In most patients with uncomplicated acute pancreatitis, there is no need for radiologic confirmation or work-up. However, in some patients, the diagnosis may be in doubt, or associated abnormalities or complications of acute pancreatitis may be suspected by the patient's protracted course or severity of disease. In these patients, radiology can be extremely helpful. CT is the best single radiologic imaging modality to evaluate these patients. With modern scanners, there are no failures, and CT provides a complete view of the pancreas and peripancreatic tissues, despite overlying bowel gas or other anatomic features that may limit the sonographic evaluation. Sonography may be helpful in evaluating possible biliary complications of acute pancreatitis, in evaluating thin patients with a good sonic window to the pancreas, or in evaluating patients who have a clearly defined complication such as a large pseudocyst. Sonography is also helpful for serial studies following the size of the fluid collection. The complications of pancreatitis include fluid collections and pseudocysts, which may become infected or develop bleeding within them, vascular complications including occlusion of the splenic vein with secondary development of varices, pancreatic ascites, and pancreatic abscess. While these complications can be evaluated by various radiologic methods, they are most effectively evaluated by CT. However, for some cases in which the cause of a cystic mass is in doubt or for cases of suspected pancreatic abscess, radiologic studies may be unable to provide a definitive diagnosis. In these cases, percutaneous needle aspiration will assist in the diagnosis.     

Splenic and perisplenic involvement in acute pancreatitis: determination of prevalence and morphologic helical CT features

PURPOSE: The purpose of this work was to determine the prevalence and morphologic helical CT features of splenic and perisplenic involvement in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. METHOD: One hundred fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were reviewed retrospectively and independently by three observers. CT scans were scored using the CT severity index (CTSI): Pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CTSI and the presence of splenic and perisplenic involvement was calculated (K statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using the Fisher exact test. RESULTS: The severity of pancreatitis was graded as mild (n = 59 scans), moderate (n = 82 scans), and severe (n = 18 scans). Splenic and perisplenic abnormalities detected included perisplenic inflammatory fluid collections (95 scans, 58 patients), narrowing of the splenic vein (35 scans, 25 patients), splenic vein thrombosis (31 scans, 19 patients), splenic infarction (10 scans, 7 patients), and subcapsular hemorrhage (2 scans, 2 patients). No cases of splenic artery pseudoaneurysm formation, intrasplenic venous thrombosis, intrasplenic pseudocysts, or abscesses were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of abnormalities was 75.5-79.2 and 71.7-100%, respectively. A statistically significant difference between the presence of abnormalities and the severity of pancreatitis was observed (p < 0.001). CONCLUSION: Splenic vein thrombosis (19%) and splenic infarction (7%) are relatively common CT findings in association with acute pancreatitis. The CTSI proves to be accurate in predicting these complications as there is a statistically significant correlation between the prevalence of these complications and the severity of pancreatitis.     

肝内胆管脓肿的CT特征探讨

目的 肝内胆管脓肿（intrahepatic bile duct abscess,IBDA）的CT表现特点及病理基础。方法 回顾性研究1989年10月至1999年2月经手术及临床抗炎治疗后复查证实的IBDA连续性病例31例的C T资料,病因包括多种原因所致的急性梗阻性化脓性胆管炎和胆道逆行感染。所有病例分别从肝脓肿征象、胆源性征象及反映两者间相关性的征象进行观察。结果 31例中均可见肝脓肿CT表现特征（31／31,100％）。胆源性CT表现包括各种梗阻病因的特征性 CT表现和其他胆道异常表现,包括胆管扩张（29／31,93.5％）、扩张的胆管与脓肿相通（5／31,16.1％）或相紧邻（8／31,25.8％）及胆道积气（10／31,32.2％）等。前两者间相关的CT表现,包括肝脓肿上与梗阻点及其近侧扩张胆管相一致（15／31,48.4％）,肝脓肿发生于无（7／31,22.6％）或有（４／３１,１２.９％）肝内胆管积气的肝叶、肝段等。结论 ＩＢＤＡ的ＣＴ表现包括肝脓肿征象、胆源性征象,并能反映两者间相关的具有一定特征的ＣＴ征象。     

Significance of extrapancreatic findings in computed tomography (CT) of acute pancreatitis

Computed tomography (CT) has proven reliable in the early detection of acute haemorrhagic pancreatitis. In the present study the extrapancreatic changes at CT were studied in 60 patients with acute pancreatitis. The CT findings were correlated to the early "prognostic signs" by Ranson and the clinical course of the disease. All the patients with minor extrapancreatic changes recovered without complications. When moderate to severe extrapancreatic changes were seen the incidence of haemorrhagic pancreatitis and the risk of development of pseudocyst or abscess was high. In these patients a dynamic contrast enhanced CT should be done in order to select the patients with haemorrhagic pancreatitis.     

Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients

PURPOSE: The lack of ductal continuity between a viable pancreatic tissue and the gastrointestinal tract results in the disconnected pancreatic duct syndrome (DPDS). The purpose of our study is to describe accurately the imaging features of CT scanning and endoscopic retrograde pancreatography (ERCP) that define the DPDS. METHODS: We conducted a retrospective analysis of the computed tomography (CT) and ERCP examinations in 26 consecutive patients with surgically proven disconnected pancreatic ducts treated over a 5-year period at our institution. Two abdominal radiologists concurrently defined the imaging features (presence and size of fluid collection along the course of the pancreatic duct, upstream enhancing pancreatic parenchyma, and ERCP abnormalities) via consensus for both exams. Patient demographics, etiology of pancreatitis, surgical treatment, initial CT interpretation, and the delay between symptom onset to correct diagnosis were recorded. RESULTS: A discrete, intrapancreatic fluid collection (average size = 27 cm2 (range, 4-74 cm2) along the course of the main pancreatic duct with upstream viable pancreatic parenchyma was identified by CT in 26 cases. ERCP showed ductal obstruction at the level of the intrapancreatic fluid collection in all patients with extravasation of contrast in 14 (54%). All patients were treated by operation: 15 (58%) by internal drainage into a Roux-en-Y limb of jejunum and 11 (42%) by distal pancreatic resection. No prior CT interpretation correctly identified DPDS. The average delay between symptom onset and definitive diagnosis was 9.3 months (range, 3-36 months). CONCLUSIONS: A discrete intrapancreatic fluid collection along the expected course of the main pancreatic duct with viable upstream pancreatic parenchyma suggests the diagnosis of DPDS. ERCP findings of ductal obstruction at the level of this fluid collection with or without contrast extravasation confirm this diagnosis. Treatment is surgical and requires either internal drainage or distal pancreatic resection for complete resolution.     

Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings

OBJECTIVE: To determine the prevalence and morphologic helical computed tomography (CT) features of peripancreatic vascular abnormalities in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. MATERIALS AND METHODS: One hundred and fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were retrospectively and independently reviewed by three observers. CT scans were scored using the CT severity index (CTSI): pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CT severity index and the presence of peripancreatic vascular abnormalities was calculated (K-statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using Fisher's exact test. RESULTS: The severity of pancreatitis was graded as mild (n = 59 scans), moderate (n = 82 scans), and severe (n = 18 scans). Venous abnormalities detected included splenic vein (SV) thrombosis (31 scans, 19 patients), superior mesenteric vein (SMV) thrombosis (20 scans, 14 patients), and portal vein (PV) thrombosis (17 scans, 13 patients). Arterial hemorrhage occurred in five patients (6 scans). In our series, no cases of arterial pseudoaneurysm formation were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of major vascular abnormalities was 75.5-79.2 and 86.2-98.8%, respectively. The presence of the vascular abnormalities in correlation with the severity of pancreatitis was variable. CONCLUSION: Vascular abnormalities are relatively common CT findings in association with acute pancreatitis. The CT severity index is insufficiently accurate in predicting some of these complications since no statistically significant correlation between their prevalence and the severity of pancreatitis could be established.     

肾前筋膜增厚的CT表现对鉴别诊断胰腺炎与胰腺癌的价值

目的：评价肾前筋膜增厚的CT表现在鉴别胰腺炎与胰腺癌诊断中的价值。方法：回顾性分析63例临床及CT复查证实为胰腺炎的肾前筋膜增厚征象，并与25例手术病理证实为胰腺癌的CT表现对照。胰腺炎中43例及25例胰腺癌做平扫加增强，20例胰腺炎仅做平扫。结果：胰腺炎组肾前筋膜增厚59例（占93％），其中急性胰腺炎肾前筋膜增厚49例（占98％），慢性胰腺炎肾前筋膜增厚10例（占77％）。胰腺癌25例中，1例肾前筋膜增厚，占4％。结论：肾前筋膜增厚的征象对胰腺炎与胰腺癌的诊断有鉴别意义。     

小网膜囊CT检查的临床价值

本文对小网膜囊的尸体和病变的研究，来讨论小网膜囊正常和异常的ＣＴ解剖。小网膜囊病变包括：积液（３５例）、脂肪肉瘤（１例），以及胰腺炎（２１例）、胰腺癌（１３例）、胃癌（６例）、胃平滑肌肉瘤（５例）侵入小网膜囊。研究结果表明，ＣＴ是评价小网膜囊病变的主要诊断手段，它能明确小网膜囊病变。     

肝内胆管脓肿的CT诊断

目的 :探讨肝内胆管脓肿的CT诊断和鉴别诊断。方法 :回顾性分析经临床、病理证实的 2 7例肝内胆管脓肿患者的CT表现及临床资料。结果 :2 7例均可见肝脓肿及胆源性病变表现。肝脓肿CT平扫表现为低密度肿块 ,单发圆形(8例 )、多房或簇状 (9例 )或不规则多发 (10例 ) ,增强扫描示脓肿实质部分明显强化 ,呈“肿块缩小征”6例 ,“周围充血征”8例 ,“簇状征”9例 ,“环靶征”仅 4例。胆源性病变CT表现包括胆管扩张、胆管壁增厚并明显强化 ,胆道积气及胆道结石等。结论 :CT扫描可发现肝脓肿及胆道病变 ,是临床诊断肝内胆管脓肿最可靠的影像学方法。