摘要
Background:Walled-off pancreatic necrosis(WOPN)is an important complication of acute pancreatitis that is diagnosed by imaging modalities such as endoscopic ultrasound(EUS)or magnetic resonance imaging(MRI),which can clearly visualize necrotic debris.The effectiveness of abdominal ultrasound(USG)in detecting solid debris in WOPN is not clear.Methods:A total of 52 patients(37 males,mean age 38.9612.6 years)with symptomatic WOPN were prospectively studied using EUS,MRI and USG.These investigations were done at a mean of 11.765.5 weeks of onset of acute pancreatitis and within two days.Results:WOPN was detected by EUS&MRI in all patients,whereas USG could not detect it in 4(7.6%)patients(3 had predominantly solid WOPN,whereas one had air foci in WOPN).USG,MRI and EUS could detect solid debris in all patients with detectable WOPN.EUS and USG detected<10%debris in 10(20%)patients,whereas MRI detected<10%debris in 14(27%)patients.EUS and USG detected 10–40%debris in 33 patients whereas MRI detected 10–40%debris in 30(58%)patients.More than 40%debris was better characterized on EUS and MRI with both detecting>40%debris in 8 patients(15%)compared to 5(11%)patients having>40%debris on USG.EUS detected collaterals around WOPN that were not detected on USG or MRI.Conclusion:USG can characterize the majority of WOPN,with accuracy comparable to that of EUS/MRI.However its limitations are the inability to detect collaterals around WOPN and characterize collections with high solid content or air.
背景:包裹性胰腺坏死(WOPN)是急性胰腺炎一个重要并发症,主要是通过内镜超声(EUS)或磁共振成像(MRI)等影像学检查来诊断,这些检查可清晰见到坏死碎片。而腹部超声(USG)对于这些坏死碎片的发现价值目前尚不清楚。方法:52例WOPN患者(其中男性37例,年龄38.9612.6岁)被前瞻性纳入研究,分别接受EUS、MRI和USG检查。这些检查于急性胰腺炎发病后11.765.5周进行,并于2天内完成。结果:所有患者均可通过EUS和MRI诊断WOPN,而有4例(7.6%)通过USG未能发现WOPN(其中3例是固体碎片为主的坏死灶,另1例坏死灶中存在空气)。在所有发现的WOPN中,三项检查均能检测到固体坏死碎片。EUS和USG在10例(20%)患者中检测到<10%的固体碎片,而MRI这一检测比例为27%(14例)。EUS和USG在33例(63%)患者中检测到的固体碎片在10%-40%之间,MRI的这一检测比例为58%(30例)。当固体固体碎片比例>40%时,EUS和MRI则更具优势,其在8例(15%)患者中检测到>40%的固体碎片,而USG这一检测比例为11%(5例)。EUS还可以发现坏死周围组织,而USG和MRI却不能。结论:USG能对大多数WOPN进行诊断,其准确率与EUS和MRI相当。然而,ESG的局限性在于检测WOPN周围组织及诊断固体碎片比例较高或内含空气的WOPN的能力不足。
