CT和MRI对急性胰腺炎局部并发症的诊断价值研究

Study of Diagnostic Value of CT and MRI for Local Complications in Acute Pancreatitis

目的:探讨急性胰腺炎(AP)局部并发症的CT和MRI特征。方法:回顾性分析伴有局部并发症的64例急性胰腺炎患者的临床和影像资料。在CT和MRI观察局部并发症的部位、数目、CT密度/MR信号、囊内碎屑、与主胰管关系以及是否继发感染。结果:本组21例患者合并胰腺假性囊肿(PPC),共见31个PPC病灶,其中小网膜囊PPC最多(12个/31个),PPC囊内均未见坏死物;临床上8例手术切除,13例保守治疗。43例患者合并包裹性坏死(WON),WON病灶与胰管交通11例,感染伴囊内气泡5例,所有WON灶内见脂肪和/或坏死物残渣;临床上22例手术切除,21例保守治疗。急性胰周液体积聚(APFC)和急性坏死性积聚(ANC)见于AP起病的早期(2周内),CT和MRI诊断不难。结论:CT和MRI检查对于AP局部并发症具有重要的诊断价值。CT显示病灶内气泡及脂肪密度直观明了,MRI显示少量坏死物及脂肪信号更敏感,两者作用有时相互补充。

Objective： To investigate CT and MRI features of acute peripancreatic fluid collection （APFC）, acute necrotic collection （ANC）, pancreatic pseudocyst （PPC） and walled-off necrosis （WON） complicating acute pancreatitis. Methods： The image data and clinical data of 64 patients with local complications of first-onset acute pancreatitis from January 2010 to June 2016 were retrospectively analyzed. The location, number, CT density, MR signal intensity, contents, communication with main pancreatic duct or not, infection or not of the lesions were recorded. Results： In this group 21 patients with PPC had total 31 PPC lesions, 12 of 31 lesions located at the lesser omental sac, and there were no necrotic materials in the PPC. Of the 21 patients with PPC, 13 had clinically conservative treatment and 8 had surgery. There were total 43 patients with WON. The WON lesions had communication with pancreatic duct in 11 cases and accompanying infection with ＂bubble signs＂ in 5 cases. Adipose tissue and non-liquid contents without contrast enhancement on CT and MRI were found in these WON lesions. Of the 43 patients with WON, 21 patients had clinically conservative treatment and 22 had surgery. The lesions of APFC and ANC were visualized on CT and MRI in early stage of AP disease （within 2 weeks） and the diagnoses were not difficult. Conclusion： CT and MRI were of great value for identifying and diagnosing the local complications of AP. CT showed bubble and fat globules more intuitively, whereas MRI was more sensitive to detect little debris component and fat globules in the lesions.