胰腺增强CT实质期与门静脉期联合评估对急性坏死性胰腺炎的早期诊断价值
| 作者: |
1林凌霄,
1施洪,
2陶超超,
2许尚文,
3黄传英
1 解放军福州总医院体检中心，福州 350025 2 解放军福州总医院影像科，福州 350025 3 解放军福州总医院医学工程科，福州 350025 |
| 通讯: |
黄传英
Email: 3088145978@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.08.015 |
| 基金: | 福建省自然科学基金(2015J01490)。 |
摘要
目的：探讨胰腺增强CT实质期与门静脉期联合评估对急性坏死性胰腺炎(acute necrotizing pancreatitis，ANP)的早期诊断价值。方法：收集2016年1月至2017年12月收治的92例急性胰腺炎(acute pancreatitis，AP)患者的临床和影像学资料，对比有无发生胰腺坏死患者早期胰腺增强CT扫描实质期(单期)和胰腺实质期+门静脉期(双期)的CT严重指数(computed tomography severity index，CTSI)评分，通过受试者工作特征(receiver operating characteristic，ROC)曲线分析单期和双期CTSI评分对AP合并胰腺坏死的诊断效能。结果：本组25例发生胰腺坏死，67例未发生胰腺坏死。胰腺坏死患者单期和双期CTSI评分均显著高于未发生胰腺坏死患者(P<0.05)。胰腺坏死患者中，单期与双期CTSI评分差异无统计学意义(P>0.05)。未发生胰腺坏死患者中，单期CTSI评分显著高于双期(P<0.05)。ROC曲线分析发现：单期和双期CTSI评分对AP胰腺坏死均有一定诊断价值(P<0.05)。CTSI评分早期诊断胰腺坏死的敏感性、特异性和曲线下面积(AUC)，单期分别为0.960，0.478和0.666，双期分别为0.960，0.582和0.774，单期评估的AUC显著小于双期(P<0.05)。结论：单纯胰腺实质期增强CT扫描早期诊断AP胰腺坏死可能被高估、特异性较低，胰腺实质期和门静脉期联合评估有助于提高AP胰腺坏死的早期诊断效能。
关键词：
多排计算机断层扫描；胰腺炎；急性坏死；放射成像增强
Early diagnostic value of enhanced CT combined with pancreas parenchyma phase and portal venous phase for acute necrotizing pancreatitis
CorrespondingAuthor: HUANG Chuanying Email: 3088145978@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.08.015
Foundation: This work was supported by the Fujian Provincial Natural Science Foundation, China (2015J01490).
Abstract
Objective: To explore the early diagnostic value of enhanced CT combined with pancreatic parenchyma phase and portal venous phase for acute necrotizing pancreatitis (ANP). Methods: The clinical and imaging data of 92 patients with acute pancreatitis (AP) from January 2016 to December 2017 were collected. The computed tomography severity index (CTSI) scores of pancreatic parenchymal phase and pancreatic parenchymal phase combined portal vein phase were compared in patients with or without pancreatic necrosis. The diagnostic efficacy of the CTSI in the pancreatic parenchymal phase and the pancreatic parenchymal phase combined portal vein phase on pancreatic necrosis were analyzed by the receiver operating characteristic (ROC) curve. Results: In this series, 25 had pancreatic necrosis and 67 had no pancreatic necrosis. Regardless of the CTSI score of the pancreatic parenchymal phase or the pancreatic parenchymal phase combined portal vein phase for patients with pancreatic necrosis were significantly higher than those without pancreatic necrosis (P<0.05). In patients with pancreatic necrosis, there was no significant difference between the CTSI score of pancreatic parenchymal phase and pancreatic parenchyma phase combined portal venous phase. However, in patients without pancreatic necrosis, CTSI score of the pancreatic parenchymal phase was significantly higher than that of pancreatic parenchymal phase combined portal vein phase (P<0.05). ROC curve analysis showed that CTSI score of pancreatic parenchymal phase CTSI score and pancreatic parenchymal phase combined portal vein phase were of certain diagnostic value for pancreatic necrosis (P<0.05). The sensitivity, specificity and area under curve (AUC) for pancreatic parenchymal phase in diagnosing pancreatic necrosis were 0.960, 0.478 and 0.666 respectively, and 0.960, 0.582 and 0.774 respectively for the pancreatic parenchymal phase combined portal vein phase. The AUC of pancreatic parenchymal phase was significantly less than that of pancreatic parenchymal phase combined portal vein phase (P<0.05). Conclusion: Enhanced CT scan alone of pancreatic parenchymal phase imaging for early diagnosis of AP pancreatic necrosis may be overestimated and lower specificity. Combined pancreatic parenchymal phase and portal venous phase assessment can help to improve the early diagnostic efficacy of AP pancreatic necrosis.
Keywords：
multidetector computed tomography; pancreatitis; acute necrotizing; radiographic image enhancement