Role of Computed Tomography Perfusion in the Evaluation of Pancreatic Necrosis and Pancreatitis After Endoscopic Ultrasound-Guided Ablation of the Pancreas in a Porcine Model
Role of Computed Tomography Perfusion in the Evaluation of Pancreatic Necrosis and Pancreatitis After Endoscopic Ultrasound-Guided Ablation of the Pancreas in a Porcine Model
复制标题
计算机断层扫描灌注在猪模型内镜超声引导胰腺消融术后胰腺坏死和胰腺炎评估中的作用
作者：
D. Sahani;N. Holalkere;A. Kambadakone;K. Matthes;M. Mino‐Kenudson;W. Brugge
目的：评价计算机断层扫描（CT）灌注在检测内镜超声引导下无水乙醇消融猪胰腺后胰腺坏死和胰腺炎中的作用，并将评价与组织病理学相关联。研究方法：在内窥镜超声引导下，将0.9%盐水（对照）和60%、80%和100%浓度的乙醇注射到4只猪的胰尾中。在第4天，进行胰腺的动态灌注CT。灌注分析和评价增强特征，并与组织病理学对照。结果如下：80%和100%浓度的乙醇注射导致局灶性胰腺炎周围的局灶性坏死，而60%乙醇注射导致严重的局灶性胰腺炎，显微镜下坏死。与胰腺炎和正常组织相比，坏死区域显示血流量、血容量、渗透性-表面积乘积减少，平均通过时间增加（P ≤ 0.001）。在对照猪中，灌注图像和组织病理学上未观察到胰腺炎或坏死。结论：与正常组织相比，乙醇注射后胰腺坏死和胰腺炎减少了CT上的组织灌注，坏死的变化比胰腺炎更显著。这些发现可能对重症胰腺炎患者胰腺坏死的准确检测有意义。
Objectives: To evaluate the role of computed tomography (CT) perfusion in detection of pancreatic necrosis and pancreatitis after endoscopic ultrasound-guided ethanol ablation of porcine pancreas and to correlate the evaluation with histopathology. Methods: Under endoscopic ultrasound guidance, 0.9% saline (control) and ethanol at 60%, 80%, and 100% concentrations were injected into the pancreatic tails of 4 pigs. On day 4, dynamic perfusion CT of the pancreas was performed. Perfusion analysis and evaluation of enhancement characteristics were done and correlated with histopathology. Results: Ethanol injections at 80% and 100% concentrations resulted in focal necrosis surrounded by focal pancreatitis, whereas 60% ethanol injection caused severe focal pancreatitis with microscopic necrosis. The necrotic area revealed reduced blood flow, blood volume, permeability-surface area product, and increased mean transit time compared with pancreatitis and normal tissue (P ≤ 0.001). In the control pig, no pancreatitis or necrosis was observed on perfusion images and histopathology. Conclusions: Pancreatic necrosis and pancreatitis after ethanol injection reduced the tissue perfusion on CT in comparison to normal tissue, with the changes being more substantial in necrosis than pancreatitis. These findings have possible implications in the accurate detection of pancreatic necrosis in patients with severe pancreatitis.