重症急性胰腺炎病人腹壁受累的多层螺旋CT及MRI研究

Multi-slice CT and MRI study of abdominal wall involvement in patients with severe acute pancreatitis

目的探究多层螺旋CT(MSCT)及MRI在重症急性胰腺炎(SAP)病人腹壁受累中的诊断价值。方法 2018年1月~2019年12月本院诊治的SAP病人78例,均行MSCT、MRI检查,以病理结果为金标准,评估MSCT、MRI检查在SAP腹壁受累中诊断价值,观察SAP病人腹壁受累MSCT、MRI影像学表现,比较MSCT、MRI对SAP腹壁受累部位、深度的检出率。结果 MSCT诊断SAP病人腹壁受累的准确率为87.18%(68/78)、灵敏度为88.57%(31/35),MRI诊断SAP病人腹壁受累的准确率为91.03%(71/78)、灵敏度为94.29%(33/35),MRI诊断SAP病人腹壁受累部位检出率为91.43(32/35),MSCT检出率为80.00%(28/35),但差异无统计学意义(P>0.05)。MRI诊断SAP病人腹壁受累深度检出率为94.29%(33/35),MSCT检出率为77.14%(27/35),两组比较差异有统计学意义(P<0.05)。SAP病人腹壁受累MSCT表现为腹壁皮下脂肪内密度升高,见条索状影,腹壁及肌肉间隙边界不清、腹壁肌肉处的脂肪显著增厚,信号常低于同层肌肉组织的密度。MRI扫描提示,腹壁脂肪层呈T1WI稍低、T2WI脂肪抑制序列高信号,肌肉-肌间隙密度增高且边界模糊;肌肉组织可见斑点、线条稍低、不规则高信号影等。结论 MSCT及MRI在SAP病人腹壁受累诊断价值均较高,但MRI对SAP腹壁受累部位和深度的评估价值略高于MSCT。

Objective To explore the diagnostic value of multi-slice spiral CT(MSCT) and MRI in abdominal wall involvement in patients with severe acute pancreatitis(SAP).Methods The clinical data of 78 patients with SAP diagnosed and treated in the hospital between January 2018 and December 2019 were collected.All patients completed MSCT and MRI examinations.With pathological results as the golden standard,the diagnostic value of MSCT and MRI examinations in SAP abdominal wall involvement was evaluated.The MSCT and MRI findings of SAP abdominal wall involvement were observed.The detection rates of the location and depth of SAP abdominal wall involvement by MSCT and MRI were compared.Results The accuracy and sensitivity of MSCT for diagnosis of abdominal wall involvement in patients with SAP were 87.18%(68/78) and 88.57%(31/35).The accuracy and sensitivity of MRI were 91.03%(71/78) and 94.29%(33/35).The detection rate of the location of abdominal wall involvement in patients with SAP by MRI [91.43(32/35)] was higher than that by MSCT [80.00%(28/35)](χ~2=1.867,P>0.05).The detection rate of the depth of abdominal wall involvement in patients with SAP by MRI [94.29%(33/35)] was significantly higher than that by MSCT [77.14%(27/35)](χ~2=4.200,P<0.05).The MSCT findings of abdominal wall involvement in patients with SAP included increased density of subcutaneous fat in the abdominal wall,strip-shaped shadows,unclear boundary between the abdominal wall and the muscle,significantly thickened fat at the abdominal wall muscle and signals lower than the density of the same layer of muscle tissue.MRI scan showed that the fat layer on the abdominal wall showed slightly low signals on T1 WI and T2 WI fat suppression sequence high signal,increased muscle-muscle gap density and unclear boundaries.Muscle tissue showed spot-like,strip-like slightly low and irregular high-signal shadows.Conclusion The diagnostic value of both MSCT and MRI are high in SAP patients with abdominal wall involvement,but the evaluation value of MRI for the locationand depth of SAP abdominal wall involvement is slightly higher than that of MSCT.