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目的探讨CT灌注成像(CTP)预测急性重型胰腺炎发生胰腺坏死的价值。方法 20例诊断为急性胰腺炎的患者,起病3天之内行CTP,观察有无胰腺缺血。20例胰腺正常的对照组同样行CTP。3周后对20例急性胰腺炎患者复查CT增强扫描观察有无胰腺坏死。结果对照组CT显示胰腺血流量(PBF)和胰腺血容量(PBV)总是大于肝脏血流量(HBF)和肝脏血容量(HBV)(P<0.01)。以对照组的扫描结果为标准,当PBF和PBV小于HBF和HBV时,认为存在胰腺缺血(P<0.01)。20例患者中10例存在胰腺缺血。3周后,存在胰腺缺血的10例患者中,有9例发生胰腺坏死;10例未发现胰腺缺血的患者均表现为急性水肿型胰腺炎,未发生胰腺坏死。CTP预测胰腺坏死的敏感度为100%,特异度为90.9%。结论 CTP能早期发现胰腺缺血,预测胰腺坏死,可以作为评价急性重型胰腺炎预后的临床指标。
Objective To investigate the value of CT perfusion imaging (CTP) in prediction of pancreatic necrosis in acute severe pancreatitis. Methods Twenty patients diagnosed as acute pancreatitis underwent CTP within 3 days of onset and observed whether there was pancreatic ischemia. 20 cases of normal control group of pancreas also CTP. Three weeks later, 20 patients with acute pancreatitis were examined by CT enhanced scan to observe the presence or absence of pancreatic necrosis. Results The control group showed that pancreas blood flow (PBF) and pancreas volume (PBV) were always greater than liver blood flow (HBF) and liver volume (HBV) (P <0.01). The results of the control group as the standard scan, when the PBF and PBV less than HBF and HBV, the existence of pancreatic ischemia (P <0.01). Pancreatic ischemia was present in 10 of the 20 patients. Three weeks later, pancreatic necrosis was observed in 9 of the 10 patients with pancreatic ischmia, and none of the 10 patients with pancreatic ischmia showed acute edematous pancreatitis without necrosis of the pancreas. CTP predicts pancreatic necrosis with a sensitivity of 100% and a specificity of 90.9%. Conclusion CTP can detect pancreatic ischemia early and predict pancreatic necrosis, which can be used as a clinical index to evaluate the prognosis of acute severe pancreatitis.