双能量CT定量参数测定预测急性胰腺炎的严重程度  

Quantitative parameters of dual⁃energy CT in predicting the severity of acute pancreatitis

作　　者：刘笑 俞杭 Liu Xiao;Yu Hang(Department of Emergency,The First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院急诊科,上海200433

出　　处：《海军医学杂志》2025年第3期302-306,共5页Journal of Navy Medicine

摘　　要：目的 探讨双能量CT(DECT)定量参数在预测急性胰腺炎(AP)严重程度方面的价值。方法 回顾性分析2022年7月至2023年7月,在海军军医大学第一附属医院经临床确诊为AP并接受胰腺DECT检查的65例患者的资料。根据亚特兰大评分标准,患者分为轻、中和重度3组。在门静脉期图像上,通过DECT多参数后处理技术,在胰腺的头、体、尾部以及腹主动脉划定感兴趣区域(ROI),测量并比较各组ROI的碘浓度、标准化碘浓度(NIC)和CT值。采用Pearson相关分析探讨这些定量参数与AP严重程度评分[急性生理与慢性健康状况评分(APACHE Ⅱ)、Marshall和Ranson评分]之间的相关性。通过绘制受试者操作特征(ROC)曲线,评估定量参数对AP严重程度预测的准确性。结果 AP患者中轻症26例,中症20例,重症19例。统计分析显示,各组间平均CT值差异无统计学意义(P=0.056),而碘浓度及NIC的差异均有统计学意义(P<0.001),且随着病情严重程度的增加,碘浓度及NIC呈下降趋势。在所有定量参数中,碘浓度与APACHE Ⅱ、Marshall和Ranson评分的相关性最强,尤其是与APACHE Ⅱ评分的相关系数为-0.728(P<0.001)。碘浓度对重症胰腺炎具有更好的预测价值,其曲线下面积(AUC)值为0.845(95%CI:0.746~0.944),以16.05 mg/ml为阈值,灵敏度为0.737,特异度为0.844。结论 双能量CT的碘浓度测定能够有效预测AP的严重程度,并为临床治疗提供指导。Objective To explore the value of quantitative parameters of dual-energy CT in predicting the severity of acute pancreatitis(AP).Methods A retrospective analysis was conducted on 65 patients who were diagnosed with AP and underwent pancreatic dual-energy CT at the First Affiliated Hospital of Naval Medical University from July 2022 to July 2023.According to the Atlanta classification,the patients were assigned to mild,moderate,or severe groups.On the images of portal venous phase,the regions of interest(ROIs)in the head,body,and tail of the pancreas,as well as in the abdominal aorta were delineated by DECT multiparameter post-processing techniques.The iodine concentration of ROIs,normalized iodine concentration(NIC),and CT values were measured.Pearson correlation analysis was used to analyze the correlation between these quantitative parameters and scoring systems of AP severity(acute physiology and chronic health evaluation[APACHE]Ⅱ,Marshall’s score,and Ranson’s score).Receiver operator characteristic(ROC)curve was used to evaluate the effectiveness of quantitative parameters in predicting AP severity.Results There were 26 patients with mild AP,20 with moderate AP,and 19 with severe AP.There was no significant difference in average CT value between groups(P=0.056),but there were significant differences in iodine concentration and NIC(P<0.001).With the increase of the severity of AP,iodine concentration and NIC showed a downward trend.Among all quantitative parameters,iodine concentration had strong correlations with APACHEⅡscore,Marshall’s score,and Ranson’s score,especially with APACHEⅡscore(r=-0.728,P<0.001).Iodine concentration had a good predictive value for severe pancreatitis,with an area under curve of 0.845(95%CI:0.746-0.944),a threshold of 16.05 mg/ml,a sensitivity of 0.737,and a specificity of 0.844.Conclusion Iodine concentration in dual-energy CT can effectively predict the severity of AP and provide guidance for clinical treatment.

关 键 词：急性胰腺炎 双能量CT 严重程度 定量参数 碘浓度 

分 类 号：R445.3[医药卫生—影像医学与核医学]