双源CT双能量扫描在急性胰腺炎病情分析中的应用价值

Value of dual-source CT dual energy scanning in analysis of acute pancreatitis

目的探讨双源CT双能量扫描在急性胰腺炎(acute pancreatitis,AP)病情分析中的应用价值。方法选取2017年1月至2019年1月四川大学华西医院收治的85例AP患者为研究对象,根据2012年修订的亚特兰大急性胰腺炎严重程度分类标准将患者分为重症急性胰腺炎(severe acute pancreatitis,SAP)组(23例)和轻症急性胰腺炎(mild acute pancreatitis,MAP)组(62例)。分析并比较两组患者动脉期碘浓度(iodine concentration of arterial phase,ICAP)、门静脉期碘浓度(iodine concentration of portal vein phase,ICPVP)、碘浓度差值(difference of iodine concentration,ICD)、动脉期标准化碘浓度(normalized iodine concentration of arterial phase,NICAP)、门静脉期标准化碘浓度(normalized iodine concentration of portal vein phase,NICPVP)以及单能量下的CT值。结果SAP组患者ICAP、ICPVP、NICAP均显著低于MAP组(均P<0.05),ICD显著高于MAP组(P<0.05)。受试者操作特征曲线结果表明,NICAP预测SAP的曲线下面积最大,达到0.856,最佳阈值为0.133,灵敏度、特异度、阳性预测值、阴性预测值分别为87.0%、83.9%、66.7%、94.5%。随着能量的升高,两组患者胰腺组织动脉期与门静脉期CT值均逐渐降低,SAP组患者80、100、120、140 keV能量下胰腺组织动脉期、门静脉期CT值均显著低于MAP组(均P<0.05)。结论双源CT双能量扫描对AP的病情分析具有重要的临床应用价值,可根据动脉期与门静脉期的碘浓度和单能量下的CT值评估胰腺组织的微循环情况。

Objective To investigate the value of dual-source CT dual energy scanning in analysis of acute pancreatitis(AP).Method Eighty-five patients with AP admitted to West China Hospital of Sichuan University from January 2017 to January 2019 were enrolled for the study and divided into severe acute pancreatitis(SAP)group(n=23)and mild acute pancreatitis(MAP)group(n=62)according to classification of severity of acute pancreatitis in Atlanta,2012.Iodine concentration of arterial phase(ICAP),iodine concentration of portal vein phase(ICPVP),difference of iodine concentration(ICD),normalized iodine concentration of arterial phase(NICAP),normalized iodine concentration of portal vein phase(NICPVP)and single-energy CT values of the two groups were compared.Result The levels of ICAP,ICPVP and NICAP in SAP group were significantly lower than those in MAP group(all P<0.05),and ICD was significantly higher than that in MAP group(P<0.05).The result of receiver operator characteristic curve analysis showed that area under the curve of NICAP predicted SAP was the maximum(reaching 0.856)and the optimal threshold was 0.133,whose sensitivity,specificity,positive predictive value and negative predictive value were 87.0%,83.9%,66.7%and 94.5%respectively.With the increase of energy,the CT values of arterial phase and portal vein phase pancreatic tissue in both groups gradually decreased,and the CT value of arterial phase and portal vein phase pancreatic tissue in SAP group were significantly lower than those in MAP group at 80 keV,100 keV,120 keV,140 keV energy(all P<0.05).Conclusion Dual-source CT dual energy scanning has important clinical value in analysis of AP.The microcirculation of pancreatic tissue can be assessed according to arterial phase and portal vein phase iodine concentration and single-energy CT value.