Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis
Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis
复制标题
DOI：
10.1053/j.gastro.2003.12.006
复制
发表时间：
2004-03-01
期刊：
影响因子：
29.4
通讯作者：
Matos, C
中科院分区：
文献类型：
--
作者：
Arvanitakis, M;Delhaye, M;Matos, C
背景和目标：本研究旨在比较磁共振成像（MRI）和计算机断层扫描（CT）评估急性胰腺炎（AP）的准确性，并探讨MRI表现与临床结局之间的相关性。方法：AP患者在入院时、入院后第7天和第30天分别行增强CT和MRI检查。用静脉注射促胰液素和对比剂进行MRI检查。Balthazar分级系统用于测量CT和MRI严重度指数（分别为CTSI和MRSI）。结果：39例患者（中位年龄47岁，范围15-86岁）进行了研究。AP为胆道病因：19例患者（49%）。入院时，7例患者（18%）的AP被临床评估为重度。CTSI和MRSI在入院时和7天后表现出很强的相关性。入院时MRSI与以下因素相关：兰森评分、入院后48小时C反应蛋白水平、住院时间和关于发病率的临床结局，包括局部和全身并发症。考虑到兰森评分为金标准，MRI检测重度AP的敏感性为83%（58-96，95% CI），特异性为91%（68-98），而CT为78%（52-93）和86%（6396）。静脉注射胰泌素后的磁共振胰胆管造影显示3例患者（8%）发生胰管渗漏。结论：MRI是AP严重程度分期的可靠方法，对疾病的预后有预测价值，并且禁忌症比CT少。它还可以检测胰管破裂，这可能发生在AP病程的早期。
Background&Aims: This study aimed to compare the accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing acute pancreatitis (AP) and to explore the correlation between MRI findings and clinical outcome. Methods: Patients with AP were investigated by contrast-enhanced CT and MRI on admission and 7 and 30 days thereafter. MRI was performed with intravenous secretin and contrast medium. Balthazar's grading system was used to measure CT and MRI severity indices (CTSI and MRSI, respectively). Results: Thirty-nine patients (median age, 47 years; range, 15-86) were studied. AP was of biliary etiology in :19 patients (49%). On admission, AP was assessed clinically as severe in 7 patients (18%). A strong correlation was demonstrated between CTSI and MRSI on admission and 7 days later. MRSI on admission correlated with the following: the Ranson score, C-reactive protein levels 48 hours after admission, duration of hospitalization, and clinical outcome regarding morbidity, including local and systemic complications. Considering the Ranson score as the gold standard, MRI detected severe AP with 83% (58-96, 95% CI) sensitivity, 91% (68-98) specificity vs. 78% (52-93) and 86% (6396) for CT. Magnetic resonance cholangiopancreatography after IV secretin injection showed pancreatic duct leakage in 3 patients (8%). Conclusions: MRI is a reliable method of staging AP severity, has predictive value for the prognosis of the disease, and has fewer contraindications than CT. It can also detect pancreatic duct disruption, which may occur early in the course of AP.