多层螺旋CT灌注成像在急性胰腺炎中的价值

Value of multi-slice CT perfusion imaging in patients with acute pancreatitis

目的:探讨多层螺旋计算机断层扫描(computed tomography,CT)灌注成像在急性胰腺炎(acute pancreatitis,AP)中的应用价值.方法:收集南方医院影像中心60例AP患者的临床资料,按照《中国急性胰腺炎诊治指南规范》分为重症急性胰腺炎(severe acute pancreatitis,SAP)30例(SAP组)和轻型急性胰腺炎(mild acute pancreatitis,MAP)30例(MAP组),选取30例胰腺正常的健康志愿者作为对照组研究对象,所有患者均进行多层螺旋CT灌注扫描,比较3组患者胰腺CT灌注参数:血流速度(blood flow,BF)、血容量(blood volume,BV)、峰值时间(time to peak,TTP)、表面通透性(permeability surface,PS),以及MAP与SAP组患者临床观测指标(腹痛缓解时间及住院总时间).结果:MAP组与SAP组患者BF和BV水平均显著低于正常组[123.79 m L/(100 mg·min)±55.35 m L/(100 mg·min)vs 214.55 m L/(100m g·m i n)±98.41 m L/(100 m g·m i n),63.55m L/(100 mg·min)±36.76 m L/(100 mg·min)vs 214.55 m L/(100 mg·min)±98.41 m L/(100m g·m i n),11.35 m L/100 m g±5.45 m L/100mg vs 18.13 m L/100 mg±14.56 m L/100 mg,7.43 m L/100 mg±2.45 m L/100 mg vs 18.13m L/100 mg±14.56 m L/100 mg],PS水平显著高于正常组[26.84 m L/(100 mg·min)±10.33 m L/(100 m g·m i n)vs 16.48 m L/(100m g·m i n)±8.67 m L/(100 m g·m i n),35.66m L/(100 mg·min)±12.45 m L/(100 mg·min)vs 16.48 m L/(100 mg·min)±8.67 m L/(100m g·m i n)],差异具有统计学意义(P<0.05);S A P组患者B F和B V水平显著低于M A P组[63.55 m L/(100 m g·m i n)±36.76 m L/(100m g·m i n)v s 123.79 m L/(100 m g·m i n)±55.35 m L/(100 m g·m i n),7.43 m L/100 m g±2.45 m L/100 mg vs 11.35 m L/100 mg±5.45 m L/100 mg],PS水平显著高于MAP组,[35.66 m L/(100 m g·m i n)±12.45 m L/(100m g·min)vs 26.84 m L/(100 mg·min)±10.33m L/(100 m g·m i n)],差异具有统计学意义(P<0.05);三组患者TTP水平比较(140.44/0.1s±23.44/0.1 s vs 142.41/0.1 s±13.95/0.1 s vs146.58/0.1 s±29.46/0.1 s),差异无统计学意义(P>0.05);SAP组患者腹痛缓解时间及住院总时间均显著长于MAP组,(64.55 h±21.35 h vs11.55 h±8.76 h,78.35 d±46.45 d vs 20.43 d±8.45 d),差异具有统计学意义(P<0.05).结论:AP患者胰腺血流灌注降低,病情与BF、BV、PS等指标紧密相关,CT灌注成像在急性胰腺炎病情评估中具有重要的临床价值.

AIM： To explore the value of multi-slice computed tomograohy（CT） perfusion imaging in patients with acute pancreatitis（AP）. METHODS： Thirty patients with severe AP（SAP）, 30 patients with mild AP（MAP）, and 30 healthy volunteers were included in this study. All subjects underwent multi-slice CT perfusion imaging. The blood flow（BF）, bloodvolume（BV）, time to peak（TTP）, permeability surface（PS）, time to abdominal pain relief, and hospital stay were compared for different groups. RESULTS： The levels of BF and BV for the MAP group and SAP group were significantly lower than those for the control group [123.79 m L/（100 mg·min） ± 55.35 m L/（100 mg·min）, 63.55 m L/（100 mg·min） ± 36.76 m L/（100 mg·min） vs 214.55 m L/（100 mg·min） ± 98.41 m L/（100 mg·min）; 11.35 m L/100 mg ± 5.45 m L/100 mg, 7.43 m L/100 mg ± 2.45 m L/100 mg vs 18.13 m L/100 mg ± 14.56 m L/100 mg, P〈0.05]. The levels of PS for the MAP group and SAP group were also significantly lower than that for the control group [26.84 m L/（100 mg·min） ± 10.33 m L/（100 mg·min）, 35.66 m L/（100 mg·min） ± 12.45 m L/（100 mg·min） vs 16.48 m L/（100 mg·min） ± 8.67 m L/（100 mg·min）, P〈0.05]. The levels of BF and BV for the SAP group were significantly lower than those for the MAP group [63.55 m L/（100 mg·min） ± 36.76 m L/（100 mg·min） vs 123.79 m L/（100 mg·min） ± 55.35 m L/（100 mg·min）, 7.43 m L/100 mg ± 2.45 m L/100 mg vs 11.35 m L/100 mg ± 5.45 m L/100 mg, P〈0.05]. The level of PS for the SAP group was significantly lower than that for the MAP group [35.66 m L/（100 mg·min） ± 12.45 m L/（100 mg·min） vs 26.84 m L/（100 mg·min） ± 10.33 m L/（100 mg·min）, P〈0.05]. There was no significant difference in the level of TTP between the three groups（140.44/0.1 s ± 23.44/0.1 s vs 142.41/0.1 s ± 13.95/0.1 s vs 146.58/0.1 s ± 29.46/0.1 s, P〈0.05）, although the time to abdominal pain relief and the hospital stay for the SAP group were longer than those for the MAP group（64.55 h ± 21.35 h vs 11.55 h ± 8.76 h, 78.35 d ±46.45 d vs 20.43 d ± 8.45 d, P〈0.05）.CONCLUSION： Patients with AP have lower pancreatic perfusion, and the disease severity has relation with the levels of BF, BV, and PS.CT perfusion imaging has important clinical value in patients with AP.