急性坏死性液体积聚和包裹性坏死并感染的影像评价

Imaging of acute necrotic collection and walled-off necrosis complicating acute pancreatitis

目的基于新亚特兰大标准,对急性坏死性液体积聚（ANC）和胰腺包裹性坏死（WON）合并感染进行CT/MRI评价。方法回顾性分析从2010年1月-2016年1月间在我院因并发感染性胰腺坏死（ANC或WON合并感染）行外科处理后将脓液标本培养证实有细菌或真菌生长者,且患者发病后3-10天首次CT或MRI检查,在感染性胰腺坏死外科治疗前后有CT或MRI复查者。综合观察感染性胰腺坏死灶的部位、数目、形态、大小、病灶密度及信号、增强特征,并计算首次CT或MR严重指数（CT/MR severity index,CTSI/MRSI）;随访患者术后演变及临床预后。结果纳入ANC或WON合并感染患者40例（男28例、女12例,年龄50.9±12.2岁）,包括ANC合并感染3例和WON合并感染37例,从患者发病至发现感染性胰腺坏死的时间为38.4±20.9 d。所有患者首次积分CTSI/MRSI为7.8±1.7分（6-10分）。37例WON合并感染者共44个胰腺WON病灶,大小为8.7±3.6 cm;所有WON病灶内含＂非液性物质影＂;56.8%的WON合并感染者见＂气泡＂征、＂气-液平＂;13.5%的WON合并感染者见胰尾部WON侵犯脾脏、脾内呈脓腔样病灶伴花环样强化及内部分隔样强化。所有患者外科引流引出褐色脓性液体后送细菌培养：67.5%的患者出现多重感染。结论 ANC或WON合并感染在CT/MRI上有较为特异的一些征象可提示诊断,能为外科治疗前后提供重要的参考价值。

Objective To investigate CT / MRI features of acute necrotic collection（ANC） and walled-off necrosis（WON）complicating acute pancreatitis. Methods The clinical records of 40 patients（28 men, 12 women, mean age ： 50.9 ±12.2 years）with first-onset acute pancreatitis complicated by ANC（3） or WON（37） from January 2010 to January 2016 were retrospectively analyzed using the 2012 revised Atlanta consensus criteria. Infectious pancreatic necrosis was confirmed by surgery and pus culture.CT or MRI performed 3 to 10 days after onset of acute pancreatitis as well as preoperative and post-operative CT or MRI were reviewed for the site, number, shape, size, CT density, MR signal intensity, enhancement pattern, and severity index. Results The average time of infectious pancreatic necrosis was 38.4 ±20.9 days from the onset of acute pancreatitis. The CT / MR severity index was 7.8±1.7（6-10） in all patients. The size of 44 WON lesions in 37 patients was 8.7±3.6 cm with non-liquid densities /signal intensities. ＂The bubble sign ＂ and / or ＂gas fluid level sign ＂ were seen in 56.8% of infectious WON lesions on MRI or CT.The spleen was involved with pancreatic tail WON in 13.5% showing rimor septal enhancement. 67.5% of patients had mixed organisms on bacterial culture. Conclusion Infectious ANC or WON has MRI and CT features that aid diagnosis and treatment planning.