主胰管胰头段水平角及开角方向与急性胰腺炎相关性的MRI研究

MRI study of the correlation between the horizontal angle and angular direction of the main pancreatic duct at the head segment in patients with acute pancreatitis

目的:探讨主胰管胰头段水平角及开角方向与急性胰腺炎的相关性。方法:回顾性连续搜集临床及上腹部MRI检查诊断为急性胰腺炎的213例患者的临床资料,按纳入和排除标准入选60例(其中男38例,女22例,平均年龄45岁)为观察组,同期收集43例正常胰腺(男22例,女21例,平均年龄53岁)为对照组。两组均行MRCP,数据上传至工作站行图像处理,在主胰管显示清晰完整的层面上连续三次测量主胰管胰头段及主胰管头尾两端连线与水平线的夹角,记录平均数值及主胰管胰头段水平角方向并行统计学分析。结果:急性胰腺炎组,主胰管胰头段及主胰管头尾两端连线与水平线的夹角分别为25.64°±20.32°和28.07°±11.11°,而正常胰腺组为30.56°±18.56°和28.65°±10.49°(t=1.254/0.253,P=0.213/0.801)。60例急性胰腺炎组中,主胰管胰头段开角向上36例,主胰管胰头段与水平线的夹角为32.19°±23.19°,向下24例,其夹角为16.08°±8.80°;43例正常胰腺组,开角方向上37例,主胰管胰头段与水平线的夹角为32.77°±18.91°,向下6例,其夹角为16.94°±7.66°。急性胰腺炎组与正常胰腺组,向上或向下开角方向,主胰管胰头段与水平线的夹角差异均无统计学意义(t=0.117/0.219,P=0.907/0.828),而主胰管胰头段与水平线的开角方向差异具有统计学意义(χ2=8.232,P=0.004)。全部病例中向上开角的角度(32.48°±20.98°)与向下开角的角度(16.26°±8.46°)间差异有统计学意义(t=4.901,P=0.000)。结论:急性胰腺炎与主胰管胰头段水平角大小无关,但与水平角的开角方向密切有关,临床急性胰腺炎多以开角向下方向为主。

Objective：To study the correlation between the horizontal angle and angular direction of the main pancreatic duct at the head segment in patients with acute pancreatitis. Methods：The clinical materials of 213 patients with acute pancreatitis diagnosed clinically via upper abdominal MR examination were recruited. According to the inclusion and exclusion criteria,60 cases （38 male and 22 female,with the average age as 45y） were selected as the study group. Meanwhile,43 normal cases （22 male and 2l female, and the average ge as 53y）, were collected as control. All of the two groups had MRCP and the data were respectively transmitted to the image post-processing station. At the layers showing main pancreatic duct clearly and continuously,the angles between the head segment of the main pancreatic duct and the horizontal line, as well as the angle between the line connecting head and the tail of main pancreatic duct and the horizontal line which were continuously measured for three times, the mean value and the direction of the horizontal angle of the head segment were recorded for statistical analysis. Results： In the group of acute pancreatitis, the angle between the head segment of the main pancreatic duct and the horizontal line, and between the line connecting the main duct of head and tail and the horizontal line were 25.64°±20.32° and 28.07°±11. 11°,respectively,while in the control group,the angle was 30.56±18.56 and 28.65°±10.49°,respectively （t=1. 254/0. 253,P=0. 213/0. 801）. Of the 60 patients with acute pancreatitis,36 patients had the angular direction of the head segment of the main pancreatic duct inclined upwardly and the angle between head segment and horizontal line was 32.19°± 23.19°;24 patients had the angular direction inclined downwardly and the angle was 16.08°±8.80°. Among the 43 cases of control group,37 cases had the angular direction inclined upwardly and the angle between the head segment and the horizontal line was 32.77°± 18.91°;6 cases had the angular direction inclined downwardly and the an gle was 16.94°±7.66°. No statistical significance was found in the angular directions （upward or downward） as well as the angle between the head segment of the main pancreatic duct and the horizontal line （t=0. 117/0. 219 ,P= 0. 907/0. 828） between study group and control group,while there was statistical difference in the angular direction of the head segment of the main pancreatic duct and the horizontal line （x^2= 8. 232,P= 0. 004）. Among all of the cases, statistical difference （t= 4. 901 ,P=0. 000） were found between the mean value of upward angle （32.48°±20.98°） and the mean value of downward angle （16.26°± 8.46°）. Conclusion：In acute pancreatitis, there is no relationship with the angle between horizontal line and the head segment of the main pancreatic duct, but there is close relationship with the angular direction. Clinically, acute pan creatitis mainly shows a downward angular direction.