急性胰腺炎胰周血管受累的磁共振表现

Peripancreatic vascular involvement in acute pancreatitis: a MRI study

目的探讨急性胰腺炎(acute pancreatitis,AP)胰周血管受累的磁共振表现、发生率;胰周血管受累与磁共振严重指数(magnetic resonance severity index,MRSI)的相关性研究。材料与方法收集川北医学院附属医院2009年8月至2013年8月期间326例AP患者资料。所有病例均签署知情同意书。AP患者均在住院后3天内行腹部平扫加增强检查。观察AP的MRI表现,行MRSI评分,观察AP的胰周血管异常表现,用Spearman法统计分析血管并发症与MRSI评分的相关性。结果326例AP患者中,轻度、中度、重度AP患者胰周血管并发症发生率分别为3%(4/124)、17%(31/180)、91%(20/22)。其中脾静脉血栓7例、肠系膜上静脉血栓5例、脾动脉受侵(炎症)47例、脾静脉受侵(炎症)49例,以上血管并发症在MRSI评分轻、中、重度患者中发生率差异具有统计学意义,并与MRSI评分呈正相关(P<0.05,0.3<r<0.5);腹腔干受侵(炎症)21例、门静脉受侵(炎症)41例、肝总动脉受侵(炎症)39例、肠系膜上动脉受侵(炎症)36例、肠系膜上静脉受侵(炎症)24例,以上并发症在MRSI评分轻、中、重度患者中发生率差异具有统计学意义,但与MRSI评分无明显相关性(P<0.05,r<0.3);门静脉血栓4例、脾动脉假性动脉瘤3例,其发生率差异不具有统计学意义,与MRSI评分也无明显相关性(P>0.05,r<0.3)。结论 AP的胰周血管并发症较为常见,脾静脉血栓、脾动静脉炎症、肠系膜上静脉血栓与急性胰腺炎的严重程度呈正相关,可以作为一个早期预测AP严重程度的指标。

Objective： To study MRI findings ofperipancreatic vascular involvement in acute pancreatitis（AP） as well as correlations between vascular involvement and the severity of acute pancreatitis according to the magnetic resonance severity index（MRSI）. Materials and Methods： A total of 326 patients with AP admitted to our institution from August 2009 to August 2013 were included in this study. All cases signed informed consent. MRI plain scan and enhanced scan were performed within 72 hours after admission. MRI findings of acute pancreatitis were noted. The peripancreatic vascular involvement was noted in AP on MR/. Spearman correlation of peripancreatic vascular involvement with the MRSI scores were analyzed. Results： At mild, moderate and severe AP according to MRSI, the prevalence of peripancreatic vascular involvement were 3%（4/124）, 17%（31/180）, 91%（20/22） respectively in 326 patients. The prevalence among splenic vein thrombosis（7 patients）, superior mesenteric vein thrombosis（5 patients）, splenic vein invasion（49 patients）, splenic artery invasion（47 patients） at mild, moderate and severe AP according to MRSI had statistics differences and was positively correlated with the MRSI score （P〈0.05, 0.3 〈r〈 0.5）. The prevalence among celiac trunk invasion （21 patients）, portal vein invasion （41 patients）, common hepatic artery invasion （39 patients）, superior mesenteric artery invasion （36 patients）, superior mesenteric vein invasion （24 patients） at mild, moderate and severe AP according to MRSI had statistics differences and was not positively correlated with the MRSI score （P〈0.05, r〈0.3）. The prevalence among portal vein thrombosis （4 patients）, splenic artery pseudoaneurysm （3 patients） at mild, moderate and severe AP according to MRSI had not statistics differences and was not positively correlated with the MRSI score （P〉0.05, r〈0.3）. Conelusions： Some patients with AP show peripancreatic vascular involvement on MRI. The prevalence of splenic vein thrombosis, superior mesenteric vein thrombosis, splenic vein invasion and splenic artery invasion has a positive correlation with the severity of AP on MRI.