Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis
Echo enhanced ultrasound: a new valid initial imaging approach for severe acute pancreatitis
复制标题
DOI：
10.1136/gut.2005.070276
复制
发表时间：
2006-01-01
期刊：
影响因子：
24.5
通讯作者：
Malfertheiner, P
中科院分区：
文献类型：
--
作者：
Rickes, S;Uhle, C;Malfertheiner, P
目的：本前瞻性研究旨在比较超声回声增强与螺旋CT（CT）评估急性胰腺炎的准确性，并探讨超声表现与临床结果之间的相关性。方法：31名患者（24名男性和7名女性，中位年龄39岁，年龄19-67岁）急性胰腺炎患者入院后72小时内行增强CT和超声检查。常规超声后行超声增强（静脉注射2.4 ml SonoVue，脉冲倒置技术，机械指数0.1 - 0.2，Siemens Elegra）。Balthazar分级系统用于测量CT和超声严重性指数（CTSI和USSI）。结果：CTSI与USSI之间呈显著正相关（r = 0.807，p <0.01），USSI与临床参数之间呈显著正相关（r = 0.807，p < 0.01）。超声检查与以下相关：兰森分数（r = 0.401，p < 0.05），入院后48小时C反应蛋白水平（r = 0.536，p < 0.01），住院时间（r = 0.422，p，0.05）和关于发病率的临床结果，包括局部和全身并发症（r = 0.363，p < 0.05）。以CT表现为金标准，以影像学标准为基础，探讨超声诊断重症急性胰腺炎的敏感性、特异性、阳性预测值和阴性预测值（Balthazar评分D或E和/或存在与坏死相容的低灌注和/或SI >= 3）分别为82%（95% CI 61 ~ 93）、89%（95% CI 57 ~ 98）、95%（95% CI 75 ~ 99）、67%（95% CI 39 ~ 86）。该手术比CT更便宜，禁忌症也更少。在将该方法纳入急性胰腺炎患者的诊断算法之前，需要进行进一步的多中心研究。
Aim: This prospective study aimed to compare the accuracy of echo enhanced ultrasound with spiral computed tomography (CT) in assessing acute pancreatitis and to explore the correlation between ultrasound findings and clinical outcome.Methods: Thirty one patients (24 men and 7 women, median age 39 years, range 19-67 years) with acute pancreatitis were investigated by contrast enhanced CT and echo enhanced ultrasound within 72 hours after admission. Echo enhanced ultrasound (with intravenous injection of 2.4 ml SonoVue, pulse inversion technique, mechanical index 0.1 to 0.2, Siemens Elegra) was performed following conventional ultrasound. Balthazar's grading system was used to measure CT and ultrasound severity indices (CTSI and USSI). Correlations between CTSI and USSI and between USSI and clinical parameters were tested by Spearman's rank correlation coefficient.Results: A strong correlation was demonstrated between CTSI and USSI (r = 0.807, p < 0.01). Ultrasound correlated with the following: the Ranson score (r = 0.401, p < 0.05), C-reactive protein levels 48 hours after admission (r = 0.536, p < 0.01), duration of hospitalisation (r = 0.422, p, 0.05), and clinical outcome regarding morbidity, including local and systemic complications (r = 0.363, p < 0.05). Based on CT findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for detecting severe acute pancreatitis based on imaging criteria (Balthazar score D or E and/ or presence of hypoperfusion compatible with necrosis and/ or SI >= 3) were, respectively, 82% (95% CI 61 to 93), 89% (95% CI 57 to 98), 95% (95% CI 75 to 99), and 67% (95% CI 39 to 86).Conclusion: Echo enhanced ultrasound produces excellent results in the staging of acute pancreatitis severity. The procedure is cheaper and has fewer contraindications than CT. Further multicentre studies need to be performed before including the method in the diagnostic algorithm of patients with acute pancreatitis.