急性胰腺炎腹膜下间隙扩散程度MR表现与临床严重程度相关性  

Correlation between clinical severity and MR features of acute pancreatitis involving sub-peritoneal spaces

作　　者：鲍志国 张小明 迟晓晓 周青 杜森 张二宁 车睿贞 BAO Zhi-guo;ZHANG Xiao-ming;CHI Xiao-xiao(Department of Radiology,the First Affiliated Hospital,Henan University,Kaifeng 47500,China)

机构地区：[1]河南大学第一附属医院放射科,河南475000

出　　处：《放射学实践》2020年第10期1278-1281,共4页Radiologic Practice

基　　金：河南省开封市科技攻关项目(1403122)。

摘　　要：目的:探讨急性胰腺炎(AP)腹膜下间隙(SPS)扩散MRI表现与临床严重程度相关性。方法:据急性胰腺炎SPS在CT扩散范围分级拟定将其在MRI扩散范围分为3级。Ⅰ级:网膜受累;Ⅱ级:Ⅰ级基础上出现小肠系膜、横结肠系膜水肿增厚、积液;Ⅲ级:Ⅱ级基础上出现结肠旁沟远处扩散,各级分别记1、2、3分。分析119例AP患者临床及影像资料对其临床急性生理和慢性健康评估Ⅱ、MR严重指数及SPS MR扩散范围分级进行评估。分析SPS在MRI上扩散范围分级与APACHEⅡ评分及MRSI相关性。结果:据MRSI评分119例AP患者中轻、中、重度AP患者腹膜下间隙受累发生率分别是16/47、63/65及7/7。MRI表现为网膜、系膜及韧带水肿增厚以及小肠、结肠系膜积液、分层同时伴有肠壁水肿及肠腔扩张、积气、积液;腹膜下间隙MR扩散范围分级评分与APACHEⅡ评分呈正相关(r=0.372,P=0.000);与MRSI评分呈较强正相关(r=0.705,P=0.000)。结论:急性胰腺炎SPS在MRI上扩散范围可反映AP局部并发症也可反映全身并发症是评价AP严重程度一个很好指标。Objective:To study the relationship between MR features of acute pancreatitis(AP)involving sub-peritoneal spaces and clinical severity.Methods:According to the grading of SPS diffusion on CT in AP,we drew up the scope of diffusion on MRI following 3 grades:Ⅰ,omentum involvement;Ⅱ:on the basis of gradeⅠ,presenting as swelling,thickening,and effusion of the mesenteric and transversemesocolon;Ⅲ:on the basis of gradeⅡ,presenting as distant diffusion of the paracolic sulcus.Ⅰ,Ⅱ,Ⅲgrades were marked as 1,2,3 points,respectively.The clinical acute physiology and chronic health evaluationⅡscoring,MR severity indexand diffusion scope of SPS on MRI were retrospectively analyzed and evaluated for 119 patients with AP.The correlation of the diffusion range grading of SPS on MRI with APACHEII and MRSI score were also analyzed.Results:According to MRSI score,the incidence of involvement of sub-peritoneal space in patients with mild,moderate and severe AP were 34%(16/47),96.9%(63/65)and 100%(7/7)among the 119 patients,respectively.MRI showed thickening of the omentum,mesangial and ligament edema,and small mesentery,colonic mesenteric effusion,stratification accompanied by intestinal wall edema,effusion and expansion,gas accumulation.The diffusion range grading of SPS on MRI presented as weak and positive correlation with APACHEII score(r=0.372,P=0.000),and strong and positive correlation with MRSI score(r=0.705,P=0.000).Conclusion:The diffusion range grading of SPS on MRI,which can reflect both local and systemic complications of AP,is a good indicator for the severity of AP.

关 键 词：胰腺炎 急性坏死性 磁共振成像 腹膜后间隙 疾病严重程度 

分 类 号：R322.492[医药卫生—人体解剖和组织胚胎学] R445.2[医药卫生—基础医学]