MRI增强扫描对急性胰腺炎的诊断及预后评估的价值分析

The application value of enhanced MRI in diagnosis and prognosis evaluation of acute pancreatitis

目的探讨MRI增强扫描在急性胰腺炎(AP)诊断和预后预测中的价值。方法回顾性分析95例磁共振室行MRI增强扫描的疑似AP患者临床资料,根据MRI表现进行MRSI评分,以临床诊断结果为准,分析MRI增强扫描在AP诊断及病情评估方面的价值。追踪临床确诊AP患者院内死亡情况,分析MRSI评分对AP患者预后预测价值。结果水肿型AP MRI表现为胰腺肿大密度均匀,增强扫描强化明显,坏死型AP表现为胰腺体积增大,胰腺密度不均匀,T1WI呈稍低或等信号,T2WI呈稍高或高、低混合信号,增强扫描无强化,出现不均质液体成分可强化。MRI诊断AP灵敏度94.74%,特异度89.47%,阳性预测值97.30%,阴性预测值80.95%,受试者工作特征曲线(ROC)分析MRI增强扫描诊断AP的曲线下面积(AUC)为0.921。MRSI诊断AP严重程度的正确率为82.89%,与临床诊断一致性较好(Kappa值=0.783,P值=0.000)。死亡组MRSI评分高于存活组[(7.21±2.03)分VS(4.05±1.27)分,P<0.05],二元Logistic回归分析MRSI评分与SP患者院内死亡具有显著相关性(OR=1.524,P=0.000),ROC分析MRSI评分预测AP患者院内死亡的AUC为0.827,灵敏度80.95%,特异度85.45%。结论MRI增强扫描在AP诊断,病情严重程度和预后评估方面均具有较高应用价值。

Objective To investigate the application value of enhanced MRI in diagnosis and prognosis evaluation of acute pancreatitis(AP).Methods The clinical data about 95 patients with suspected AP who underwent enhanced MRI scans in our hospital were retrospectively analyzed.According to the results of MRI examination,the MRSI acore was performed.The clinical diagnosis results were taken as the criteria,the application value of enhanced MRI scanning in diagnosis and prognosis evaluation of AP was analyzed.Tracing the hospital mortality of patients who were clinically confirmed to analyze the predictive value of MRSI score in the prognosis evaluation of patients with AP.Results The MRI manifestations of edematous AP were homogeneous density of pancreatic enlargement and obviously enhanced scan.However the MRI manifestations of necrotic AP were the enlarged volume of the pancreas,the uneven density of the pancreas,the slightly low or equal density T1WI signal,the slightly high or high-low mixed density T2WI signal,moreover there was no enhancement signals of enhanced scan,and the heterogeneous liquid component could be enhanced.The sensitivity,specificity,positive predictive value and negative predictive value of MRI in the diagnosis of AP were 94.74%,89.47%,97.30%and 80.95%,respectively.The receiver operator characteristics curve(ROC)analysis showed that the area under curve(AUC)of enhanced MRI diagnosis AP was 0.921.The accuracy rate of MRSI in diagnossis of the severity of AP was 82.89%,which was in good agreement with clinical diagnosis(Kappa value=0.783,P<0.05).The MRSI scores in death case group were significantly higher than those in survival case group(P<0.05).The binary logistic regression analysis showed there was a significant correlation between MRSI score and the mortality within hospital of patients with AP(P<0.01).The results of ROC analysis showed that the AUC in predicting the mortality within hospital 0.827,and the sensitivity,the specificity were 80.95%and 85.45%,respectively.Conclusion Enhanced MR scan has important application value in the diagnosis,prognosis evaluation of severity of AP.