胰腺损伤的多层螺旋CT诊断

Multi-Slice Spiral CT Scanning for the Diagnosis of Pancreas Trauma

目的总结胰腺损伤的多层螺旋CT(MSCT)征象,探讨MSCT对该病的诊断价值。方法回顾性分析13例胰腺损伤的MSCT平扫和增强扫描资料;根据胰实质损伤的深度分为表浅伤(创伤小于胰腺厚度的50%)和深部伤(创伤大小胰腺厚度的50%),根据损伤部位边界是否清楚分为挫伤和裂伤。分析各种损伤的CT表现及伴发其他脏器损伤情况。由2名腹部诊断组高年资医师独立阅片,以共同意见为准。结果胰腺表浅伤3例,包含挫伤2例,裂伤1例;胰腺深部伤10例,包含挫伤2例,次全断裂伤6例,完全断裂伤2例,11例患者伴发其他脏器损伤。CT平扫首诊漏诊2例,CT增强扫描较平扫能清楚显示胰腺损伤范围及伴发损伤。结论 MSCT能清楚显示胰腺损伤的部位、范围、严重程度以及邻近脏器伴发性损伤,为临床选择治疗方案提供重要依据。

Objective To sum up the multi-slice spiral CT （MSCT） features of pancreas trauma and to assess its diagnostic value. Methods Both plain and contrast-enhanced MSCT findings in 13 patients with pancreas trauma were retrospectively analyzed. Based on the traumatic depth of pancreatic parenchyma the pancreatic injuries were divided into superficial trauma （ 〈50% thickness of the pancreas） and deep trauma （ 〉50% thickness of the pancreas）. According to the distinguishable or indistinguishable border, the pancreatic injuries were classified into contusion and laceration. CT manifestations of the injuries and the concomitant injured organs were evaluated. The CT scans were reviewed by two senior abdominal radiologists, and the common opinion of the two radiologists was taken for the final diagnosis. Results Superficial pancreatic injuries were seen in 3 patients, including contusion in 2 cases and laceration in one case. Deep pancreatic trauma was demonstrated in 10 patients, including contusion in 2 cases, sub-total laceration in 6 cases and complete laceration in 2 cases. Concomitant injuries of other organs were observed in 11 patients. Two cases missed diagnosis on initial plain CT scanning. Contrast-enhanced CT scanning was superior to plain CT scanning in displaying the extent and concomitant injured organs. Conclusion MSCT scanning can clearly reveal the sites, extent and severity of the pancreatic trauma, as well as the concomitant injuries of the neighboring organs, which is very helpful in selecting optimal therapeutic scheme.