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目的:探讨多层螺旋计算机断层扫描(computed tomography,CT)灌注成像在急性胰腺炎(acute pancreatitis,AP)中的应用价值.方法:收集南方医院影像中心60例AP患者的临床资料,按照《中国急性胰腺炎诊治指南规范》分为重症急性胰腺炎(severe acute pancreatitis,SAP)30例(SAP组)和轻型急性胰腺炎(mild acute pancreatitis,MAP)30例(MAP组),选取30例胰腺正常的健康志愿者作为对照组研究对象,所有患者均进行多层螺旋CT灌注扫描,比较3组患者胰腺CT灌注参数:血流速度(blood flow,BF)、血容量(blood volume,BV)、峰值时间(time to peak,TTP)、表面通透性(permeability surface,PS),以及MAP与SAP组患者临床观测指标(腹痛缓解时间及住院总时间).结果:MAP组与SAP组患者BF和BV水平均显著低于正常组[123.79 m L/(100 mg·min)±55.35 m L/(100 mg·min)vs 214.55 m L/(100m g·m i n)±98.41 m L/(100 m g·m i n),63.55m L/(100 mg·min)±36.76 m L/(100 mg·min)vs 214.55 m L/(100 mg·min)±98.41 m L/(100m g·m i n),11.35 m L/100 m g±5.45 m L/100mg vs 18.13 m L/100 mg±14.56 m L/100 mg,7.43 m L/100 mg±2.45 m L/100 mg vs 18.13m L/100 mg±14.56 m L/100 mg],PS水平显著高于正常组[26.84 m L/(100 mg·min)±10.33 m L/(100 m g·m i n)vs 16.48 m L/(100m g·m i n)±8.67 m L/(100 m g·m i n),35.66m L/(100 mg·min)±12.45 m L/(100 mg·min)vs 16.48 m L/(100 mg·min)±8.67 m L/(100m g·m i n)],差异具有统计学意义(P<0.05);S A P组患者B F和B V水平显著低于M A P组[63.55 m L/(100 m g·m i n)±36.76 m L/(100m g·m i n)v s 123.79 m L/(100 m g·m i n)±55.35 m L/(100 m g·m i n),7.43 m L/100 m g±2.45 m L/100 mg vs 11.35 m L/100 mg±5.45 m L/100 mg],PS水平显著高于MAP组,[35.66 m L/(100 m g·m i n)±12.45 m L/(100m g·min)vs 26.84 m L/(100 mg·min)±10.33m L/(100 m g·m i n)],差异具有统计学意义(P<0.05);三组患者TTP水平比较(140.44/0.1s±23.44/0.1 s vs 142.41/0.1 s±13.95/0.1 s vs146.58/0.1 s±29.46/0.1 s),差异无统计学意义(P>0.05);SAP组患者腹痛缓解时间及住院总时间均显著长于MAP组,(64.55 h±21.35 h vs11.55 h±8.76 h,78.35 d±46.45 d vs 20.43 d±8.45 d),差异具有统计学意义(P<0.05).结论:AP患者胰腺血流灌注降低,病情与BF、BV、PS等指标紧密相关,CT灌注成像在急性胰腺炎病情评估中具有重要的临床价值.
Objective: To investigate the value of multi-slice computed tomography (CT) perfusion imaging in acute pancreatitis (AP) .Methods: The clinical data of 60 patients with AP in the Southern Hospital Imaging Center were collected, 30 cases of severe acute pancreatitis (SAP) and 30 cases of mild acute pancreatitis (MAP) were selected and 30 cases of normal pancreas Healthy volunteers as control group. All patients underwent multi-slice spiral CT perfusion scan. CT perfusion parameters were compared among three groups: blood flow (BF), blood volume (BV), peak Time to peak (TTP) and permeability surface (PS), as well as the clinical observation indexes (pain relief time and total hospital stay time) in MAP and SAP group.Results: The BF and BV (123.79 m L / (100 mg · min) ± 55.35 m L / (100 mg · min) vs 214.55 m L / (100 m g · min) ± 98.41 m L / (100 mg · min), respectively ), 63.55 m L / (100 mg · min) ± 36.76 m L / (100 mg · min) vs 214.55 m L / ( 100 mg · min -1 · 100 mg · min -1 · 11.35 m L / 100 mg ± 5.45 m L / 100 mg vs 18.13 m L / 100 mg ± 14.56 m L / 100 mg · 7.43 m L / 100 mg · 100 mg · min -1 ± 2.45 m L / 100 mg vs 18.13 m L / 100 mg ± 14.56 m L / 100 mg], PS level was significantly higher than that of the normal group [26.84 m L / (100 mg · min) ± 10.33 m L / (100 mg · min vs 16.48 m L / 100 m g · min ± 8.67 m L / 100 mg · min, 35.66 m L / 100 mg · min ± 12.45 m L / 100 mg · min vs 16.48 m L (100 mg · min ± 8.67 m L / 100 m g · min), the difference was statistically significant (P <0.05) mg · min ± 36.76 m L / 100 m g · min vs 123.79 m L / 100 mg · min ± 55.35 m L / 100 mg · min, 7.43 m L / 100 mg ± 2.45 m L / 100 (P <0.05), PS level was significantly higher than that of MAP group [35.66 m L / (100 mg · min) ± 12.45 m L / (100 m g · min) vs 26.84 m vs 11.35 m L / 100 mg ± 5.45 m L / 100 mg] (P <0.05). The level of TTP in the three groups was significantly higher than that in the control group (140.44 / 0.1s ± 23.44 / 0.1 s vs 142.41 / L, 100 mg · min ± 10.33 m L / 100 mg · min) /0.1 s ± 13.95 / 0.1 s vs146.58 / 0.1 s ± 29.46 / 0.1 s), the difference was not statistically significant (P> 0.05). The pain relief time and total hospital stay time in SAP group were significantly longer than MAP group (64.55 h ± 21.35 h vs 11.5 h ± 8.76 h, 78.35 d ± 46.45 d vs 20.43 d ± 8.45 d), the difference was statistically significant (P <0.05) .Conclusion: Pancreatic perfusion decreases in patients with AP, and the disease is closely related to the indexes of BF, BV and PS. CT perfusion imaging has important clinical value in the evaluation of the disease of acute pancreatitis.