多层螺旋CT灌注成像在早期急性坏死性胰腺炎的临床应用

Clinical application of multi-slice CT perfusion imaging in early stage of acute necrotizing pancreatitis

目的探讨CT灌注成像在早期急性坏死性胰腺炎中的应用。方法 45例胰腺炎患者被分成轻型胰腺炎(n=26)及坏死性胰腺炎(n=19)两组,给予胰腺灌注扫描,比较两组CT灌注参数BF、BV、MTT、PS并进行统计学分析;3周后,胰腺炎患者予常规增强CT扫描,判断灌注扫描对怀疑胰腺坏死的敏感性及特异性。结果坏死性胰腺炎患者的BF和BV水平显著低于轻型胰腺炎组,差异具有统计学意义(P<0.05);MTT和PS水平两组比较,差异无统计学意义(P>0.05)。45例胰腺炎患者,CT灌注怀疑19例胰腺坏死,3周后复查CT增强检查,19例胰腺坏死中的17例出现阳性,2例出现假阳性,灌注排除坏死的患者中未出现胰腺坏死病例,敏感性为100.0%,特异性为93.3%。结论 CT灌注成像对早期急性坏死性胰腺炎有较高的敏感性。

Objective To investigate the perfusion changes associated with acute necrotizong pancreatitis（ANP） at an early age using the multi-slice computed tomograohy（CT） perfusion imaging. Methods A total of 45 patients with acute pancreatitis underwent CT perfusion imaging were divided into two groups, 26 patients with mild AP（MAP） and 19 pa tients with ANP. The CT perfusion parameters including blood flow（BF）, blood volume（BV）, mean transit time（MTT）and permeability-surface area product（PS） were compared, and the correlation between the parameters was analyzed in statistic. After three weeks, all the patients underwent conventional contrast-enhanced CT scan, to judge the sensitivity and specificity of perfusion image in the patients with pancreatic necrosis. Results The levels of BF and BV for the ANP group were significantly lower than those for MAP group（P〈0.05）; The levels of PS and MTT were not statistically significant（P〉0.05）. 19 patients were diagnosed with ANP by using CT perfusion, of which, 17 patients were confirmed by conventional contrast-enhanced CT scan after 3 weeks. All the patients who had no perfusion defects detected in the perfusion CT image were diagnosed with mild AP 3 weeks later. The sensibility and specificity of diagnosing the early ANP by using the perfusion CT was 100.0% and 93.3%, separately. Conclusion Perfusion CT was more sensitive in diagnosing ANP at an early stage.