磁共振弥散加权成像与CT对急性胰腺炎严重程度的分级评估

Evaluation of the severity of acute pancreatitis by diffusion weighted magnetic resonance imaging and CT

目的探讨磁共振弥散加权成像(DWI)与CT在急性胰腺炎(AP)严重程度分级诊断中的价值。方法回顾性分析本院收治的54例急性胰腺炎患者的临床、含有DWI的MRI、CT资料。采用MRI严重指数(MRSI)、CT严重指数(MCTSI)与临床的Ranson评分进行对照,比较两种指数与临床诊断的符合率;测量各级炎症胰腺的ADC值,应用单因素方差分析(ANOVA)对各级别AP之间的ADC值进行统计学分析。结果在判断急性胰腺炎严重程度的分级诊断符合率方面MRSI(89.5%,17/19)高于MCTSI(78.5%,15/19),但是两者符合率比较差异无统计学意义(X^2=0.198,P=0.656)。A、B、C、D、E级AP的平均ADC值分别为(1.120±0.015)×10^(-3)mm^2/s、(1.185±0.165)×10^(-3)mm^2/s、(1.410±0.123)×10^(-3)mm^2/s、(1.450±0.168)×10^(-3)mm^2/s、(1.830±0.540)×10^(-3)mm^2/s。A、B级AP的ADC值低于E级,但差异无统计学意义,D、E级之间的ADC值差异无统计学意义。结论 MRI与CT在评价急性胰腺炎严重程度方面具有一致性,但磁共振DWI成像有利于Balthazar中A、B、C级AP的早期诊断。

Objective To investigate the value of diffusion weighted imaging（DWI） and CT in the diagnosis of acute pancreatitis（AP）.Methods The clinical features, MRI and CT findings of 54 patients with acute pancreatitis were analyzed retrospectively. The MRI severity index（MRSI）, CT severe index（MCTSI） and ranson score were used to compare the coincidence rate between the two indices and clinical diagnosis. The ADC values of the inflammatory pancreas at all levels were measured and the ADC values between different levels of AP were statistically analyzed by single factor analysis of variance（ANOVA）. Results MRSI（89.5%, 17/19） was higher than MCTSI（78.5%, 15/19） in judging the compliance rate of the severity of acute pancreatitis, but there was no significant difference between the two groups（χ^2=0.198, P=0.656）. The average ADC values of A, B, C, D and E AP are（1.120±0.015）×10^-3mm^2/s,（1.185±0.165）×10^-3mm^2/s,（1.410±0.123）×10^-3mm^2/s,（1.450±0.168）×10^-3mm^2/s,（1.830±0.540）×10^-3mm^2/s. The ADC values of the A and B AP were lower than those of E, but there was no statistical significance, the ADC values between D and E were not statistically significant. Conclusion MRI and CT are consistent in evaluating the severity of acute pancreatitis, but MRI DWI is helpful for the early diagnosis of balthazar A, B and C.