分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT诊断急性胰腺炎继发胃肠瘘  

Abdominal no Contrast and Contrast-Enhanced Multi-Slice CT After Orally Diluted Iodide in Diagnosis of Time Segment for Gastrointestinal Fistula Secondary to Acute Pancreatitis

作　　者：黄鹂 周广 李国光[3,4] 李光义[5] 谭显政[3] 雷衍军[1] HUANG Li;ZHOU Guang;LI Guoguang;LI Guangyi;TAN Xianzheng;LEI Yanjun(Department of Critical Care Medicine,Hunan Provincial People’s Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;不详)

机构地区：[1]湖南省人民医院(湖南师范大学第一附属医院)重症医学科,湖南长沙410005 [2]湖南省人民医院(湖南师范大学第一附属医院)放射科,湖南长沙410005 [3]湖南省人民医院(湖南师范大学第一附属医院)胰脾外科,湖南长沙410005 [4]湖南师范大学胰腺疾病转化医学研究所,湖南长沙410005 [5]湖南省人民医院(湖南师范大学第一附属医院)普外二科,湖南长沙410005

出　　处：《中国医学影像学杂志》2024年第1期87-93,共7页Chinese Journal of Medical Imaging

基　　金：湖南省教育厅科学研究项目(21C0024)。

摘　　要：目的评价分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT在诊断急性胰腺炎(AP)继发胃肠瘘(GIF)中的应用。资料与方法回顾性选取2017年1月—2022年12月湖南省人民医院连续收集的数据库中108例AP后期患者,记录其人口学信息和临床特征,行分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT筛查GIF,以此后5 d内的临床综合诊断结果作为参考标准,计算分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT诊断AP继发GIF的敏感度、特异度、阳性预测值、阴性预测值和准确度,评价两种方法诊断结果的一致性。结果分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT诊断AP继发GIF的敏感度为91.5%(95%CI 78.7%~97.2%),特异度为98.4%(95%CI 90.0%~99.9%),阳性预测值为97.7%(95%CI86.5%~99.9%),阴性预测值为93.8%(95%CI 84.0%~98.0%),准确度为95.4%(95%CI 91.4%~99.3%);两种方法的诊断结果一致性非常好,Kappa值为0.905;Mc Nemar’s检验P=0.375,提示两种方法诊断GIF及其亚组的结果差异均无统计学意义。结论分时段口服稀释碘剂后全腹部平扫及增强多层螺旋CT可简单、无创、快速、准确诊断AP继发GIF,为临床诊疗提供更早、更精确和更可靠的影像依据。Purpose To evaluate the diagnostic accuracy of abdominal plain scan and contrast-enhanced multi-slice CT after orally diluted iodide in time segment(Post-ODI ANCCE-MSCT)for gastrointestinal fistula(GIF)secondary to acute pancreatitis(AP).Materials and Methods A total of 108 patients with late AP in the prospective and continuously collected database of Hunan Provincial People’s Hospital from January 2017 to December 2022 were retrospectively extracted.Their demographic information and clinical features were recorded and GIF were screened by Post-ODI ANCCE-MSCT.The comprehensive clinical diagnosis results within 5 days thereafter were used as reference standards.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Post-ODI ANCCE-MSCT for diagnosing GIF secondary to AP were calculated using a four-cell table,and the consistency of the two methods was evaluated by Kappa test and McNemar’s test.Results Sensitivity was 91.5%(95%CI 78.7%-97.2%),specificity was 98.4%(95%CI 90.0%-99.9%),positive predictive value was 97.7%(95%CI 86.5%-99.9%),negative predictive value was 93.8%(95%CI 84.0%-98.0%),and the accuracy was 95.4%(95%CI 91.4%-99.3%),respectively.The Kappa value was 0.905,and P value was 0.375 via McNemar’s test.Conclusion Post-ODI ANCCE-MSCT can diagnose GIF secondary to AP in a simple,non-invasive,rapid and accurate way,and provide earlier,more accurate and reliable image basis for clinical diagnosis and treatment.

关 键 词：胰腺炎 胃肠瘘 诊断 造影剂 体层摄影术 螺旋计算机 

分 类 号：R576[医药卫生—消化系统] R816.5[医药卫生—内科学] R445.3[医药卫生—临床医学]