影像组学和基因组学在急性胰腺炎中的应用进展

对急性胰腺炎（AP）的严重程度、发展趋势做出准确、及时的判断,并根据其潜在的病理机制给予及时、个性化的治疗和干预是临床亟待解决的问题。通过影像组学和基因组学结合来提高对AP的诊断能力并提供预测其发展的生物标志物是当今临床研究的新方向。影像组学可以挖掘医学影像中肉眼不能识别的数据,从而预测AP的严重程度、并发症、复发及胰周坏死;基因组学则能用于分析AP的基因背景,有助于研究AP的分子机制。就影像组学和基因组学在AP中的应用研究进展进行综述。     

急性胰腺炎伴发胸腔积液的MDCT表现及解剖基础

目的：研究急性胰腺炎（AP）向纵隔扩散并致胸腔积液（PE）的 CT 表现、解剖通道,以及与急性胰腺炎 CT 严重指数（CTSI）和急性生理慢性健康评分系统Ⅱ（APACHEⅡ）的相关性。方法：回顾分析119例因 AP 入院并行 CT 检查患者。观察 PE 发生率、胰周积液向纵隔扩散的解剖途径并评分分级;AP 的严重程度用 CTSI 及 APACHEⅡ评分分级并统计分析 PE 分级与 CTSI 及 APACHEⅡ评分相关性。结果：119例74．78％患者并发不同程度 PE。胰周积液向纵隔扩散时食管裂孔受累25．21％,主动脉裂孔5．04％,下腔静脉裂孔2．52％。PE 评分与 CTSI 正相关（r＝0．449,P ＜0．01）,与APACHE Ⅱ评分无相关性（r＝0．197,P ＜0．05）。结论：AP 伴发 PE 较常见,胰周积液通过膈肌裂孔向胸腔扩散。PE 也可以做为评价 AP 严重程度的辅助指标。     

新亚特兰大标准下急性胰腺炎局部并发症的MRI评价

【摘要】在急性胰腺炎（AP）2012年亚特兰大修订版分类和国际共识的新定义中,关于AP的主要局部并发症被重新定义和命名,包括急性胰周液体积聚、胰腺假性囊肿、急性坏死性积聚及胰腺包裹性坏死,每一种局部并发症又分为无菌性和感染性。影像学检查在对AP局部并发症的评价上有着举足轻重的作用,能为临床提供胰腺、胰周及胰外改变程度的客观依据,从而会影响到AP患者的治疗。尽管传统局部并发症的特征是依据增强CT表现而制定的,但在评价某些胰周积液的性质方面MRI更具有优势,即MRI能提供更多有价值的细节征象。本文就新亚特兰大诊断指南下AP局部并发症的MRI表现作一图文综述。     

仅胰周坏死型胰腺炎的临床特点及影像表现

仅胰周坏死型胰腺炎(EXPN)是指仅累及胰腺周围脂肪组织/细胞坏死,而胰腺实质未见确切坏死的一种急性坏死性胰腺炎的独立亚型。EXPN的严重程度及预后介于急性间质水肿性胰腺炎与胰腺实质坏死(伴或不伴有胰周坏死)两者之间,且其累及范围也是影响该病严重程度及预后结局的重要因素。因此,正确认识及诊断EXPN,为临床提供适宜的干预依据,对提高病人预后、降低病人死亡率具有重要意义。就EXPN的定义、流行病学、影像表现及预后予以综述。     

急性胰腺炎累及横结肠系膜的CT表现与临床严重程度相关性分析

目的探讨急性胰腺炎(AP)中横结肠系膜受累的CT表现分级与临床严重程度的相关性。方法回顾性分析98例AP螺旋CT表现,重点观察横结肠系膜受累的严重程度并进行CT分级,同时记录AP的临床严重程度。结果横结肠系膜的CT表现形态评分与AP的临床严重程度评分呈正相关(r=0.55,P<0.01)。本组轻症AP 64例,其中7例横结肠系膜积液;34例重症AP,20例横结肠系膜积液。若以横结肠系膜积液作为判断重症AP的阳性标准,则其敏感度为60%(20/34),特异度为89%(57/64),阳性预测值为74%(20/27),阴性预测值为80%(57/71),准确度为79%(77/98)。结论横结肠系膜积液的CT表现能在一定程度上反映AP的严重程度。     

急性胰腺炎微循环障碍放射学及相关基础研究

急性胰腺炎(AP)是常见急腹症之一,其早期临床表现多样,病情轻重不等,发病早期对AP严重程度的准确评估以及确定及时有效的治疗方案对预后具有决定性意义。影像检查已成为判断AP严重程度的重要手段,特别是功能成像技术的进展使得评估进一步深入,也成为近年来判断AP严重程度的研究热点。就影像检查用于AP严重程度评估的研究进展予以综述。     

儿童胰腺损伤的MSCT诊断

目的 探讨MSCT在儿童胰腺损伤的诊断价值.方法 回顾性分析经临床、实验室检查及CT明确诊断和手术探查(4例)及临床随访证实的18例闭合性腹部外伤致胰腺损伤患儿的CT表现并按损伤程度进行分级.结果 胰腺损伤CT表现的直接征象有:胰腺肿大(7例),胰腺实质裂伤(5例),实质裂伤伴胰管断裂(2例),胰腺内出血/积液(5例).间接征象有:胰周被膜和肾周筋膜增厚(6例),小网膜囊、胰周及肾旁间隙出血/积液(10例),胰周及腹膜后炎性反应(3例),胰周假性囊肿(10例).合并肝、肾及十二指肠损伤各1例,脾损伤2例.Ⅰ级7例,Ⅱ级6例,Ⅲ级3例,Ⅳ级2例.结论 结合临床及外伤病史,MSCT检查对儿童胰腺损伤能作出正确诊断并可作为首选方法.     

急性胰腺炎严重程度评估的影像研究进展

急性胰腺炎(AP)是常见急腹症之一,其早期临床表现多样,病情轻重不等,发病早期对AP严重程度的准确评估以及确定及时有效的治疗方案对预后具有决定性意义。影像检查已成为判断AP严重程度的重要手段,特别是功能成像技术的进展使得评估进一步深入,也成为近年来判断AP严重程度的研究热点。就影像检查用于AP严重程度评估的研究进展作一综述。     

急性胰腺炎相关性肺损伤的CT表现

目的 探讨急性胰腺炎(AP)相关性肺损伤(APALI)的CT表现.资料与方法 102例AP患者根据亚特兰大临床分类标准分为轻症急性胰腺炎(MAP)和重症急性胰腺炎(SAP),分析APALI的发生情况及CT表现,并进行CT形态学分级评分,分析APALI的CT形态学分级评分与AP严重程度临床分级评分的相关性.结果 102例AP共发生APALI 71例,其中MAP 41例,SAP 30例.APALI的CT表现包括:33例CT表现为胸腔积液、积血,胸膜增厚;18例出现肺内条索状或网格状影;20例出现肺内磨玻璃状模糊影或斑片状实变影;APALI的CT形态学分级评分与AP严重程度临床分级评分呈正相关(r=0.314,P＜0.05).结论 APALI的CT表现为胸腔积液、积血,胸膜增厚;肺内条索状或网格状影;肺内磨玻璃状模糊影或斑片状实变影;CT形态学分级评分与AP严重程度临床分级评分具有一定的相关性,可作为判断AP病情严重程度的影像学参考依据.     

CT结合D-二聚体对急性胰腺炎并发门静脉系血栓的探讨

目的 应用增强CT联合n二聚体检测,提高对急性胰腺炎(AP)并发门静脉系统血栓的诊断.方法 对23例已经确诊的AP并发门静脉系统血栓患者的影像学和临床资料进行回顾性分析.结果 (1)增强CT确诊21例患者并发门静脉系统血栓形成,表现静脉闭塞3支静脉、充盈缺损19支静脉、管腔变细9支静脉、管壁边缘模糊12支静脉,其血栓的部位与胰周积液分布一致.(2)23例患者D-二聚体均有不同程度升高,提示门静脉系统血栓或(和)微血栓的形成,并在一定程度上可以预测AP有无并发坏死.(3)CT Balthazar分级B级2例,D级3例,E级18例.结论 AP患者CT平扫胰周出现积液时高度提示可见血栓的形成,并建议早期行CT增强扫描.D-二聚体升高但无胰周渗出液时,则提示小静脉或(和)微循环血栓形成.     

胰腺及胰周血管强化的多层螺旋CT研究

目的　探讨多层螺旋CT增强扫描胰腺及胰周血管强化的最佳时相及扫描方案。资料与方法　采用多层螺旋CT对 19例胰腺正常的患者行动脉期、胰腺期及门脉期三期扫描 ,比较胰腺、肠系膜上动脉 (SMA)和肠系膜上静脉 (SMV)在三期图像上的强化程度 ,以及观察胰周小血管的充盈显影情况。结果　胰腺期胰腺强化程度最大 ,高于动脉期和门脉期 (P <0 .0 0 1)。SMA于动脉期强化程度最大 ,其次为胰腺期 ,两者差别无统计学意义 (P >0 .0 5 ) ,但两者均高于门脉期 (P <0 .0 0 1)。SMV于胰腺期强化程度最大 ,高于动脉期和门脉期 (P <0 .0 5 )。胰腺期胰周小动脉和小静脉均能得到较好充盈显影。结论　胰腺及胰周血管在胰腺期获得最大程度强化和充盈显影 ,胰腺CT增强扫描最佳扫描方案为胰腺期和门脉期双期扫描。如需行CTA时 ,多层螺旋CT可行三期扫描     

螺旋CT平扫对急性胰腺炎的诊断价值

目的探讨急性胰腺炎的CT平扫特征及其诊断价值。方法对经临床明确诊断的30例急性胰腺炎CT表现进行分析评价。结果30例中CT诊断为急性单纯性水肿性胰腺炎13例,表现为胰腺弥漫性或局限性增大,密度轻度减低,轮廓模糊,以及胰周积液。急性出血坏死性胰腺炎17例,表现为胰腺明显增大,密度弥漫性减低,坏死区密度更低,出血区密度高于正常组织,明显的胰周脂肪坏死和积液。结论螺旋CT平扫是急性胰腺炎简便有效的影像检查方法。     

Multi--detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma.

PURPOSE: To determine the optimal phase for enhancement of the normal pancreas and peripancreatic vasculature and the maximal tumor-to-pancreatic parenchymal enhancement difference by using multiphase, contrast material-enhanced, multi-detector row helical computed tomography (CT). MATERIALS AND METHODS: Forty-nine patients with a normal-appearing pancreas but suspected of having pancreatic abnormality and 28 patients with proved pancreatic adenocarcinoma underwent multiphase, contrast-enhanced, multi-detector row CT during the arterial phase (AP), pancreatic parenchymal phase (PPP), and portal venous phase (PVP). Attenuation values of the normal pancreas, pancreatic adenocarcinoma, celiac and superior mesenteric arteries, and superior mesenteric and portal veins were measured during all three imaging phases. Quantitative analysis of these measurements and subjective qualitative analysis of tumor conspicuity were performed. RESULTS: Maximal enhancement of the normal pancreatic parenchyma occurred during the PPP. Maximal tumor-to-parenchyma attenuation differences during the PPP and PVP were equivalent but greater than that during the AP. Subjective analysis revealed that tumor conspicuity during the PPP and PVP was equivalent but superior to that during the AP. Maximal arterial enhancement was seen during the PPP, and maximal venous enhancement was seen during the PVP. CONCLUSION: A combination of PPP and PVP imaging is sufficient for detection of pancreatic adenocarcinoma, because it provides maximal pancreatic parenchymal and peripancreatic vascular enhancement. AP imaging can be reserved for patients in whom CT angiography is required.     

Pancreatic clefts caused by penetrating vessels: a potential diagnostic pitfall for pancreatic fracture on CT

The diagnosis of pancreatic fracture using computerized tomography (CT) is made by identifying a linear defect in the pancreas, often with a variable amount of peripancreatic fluid. However, the fat surrounding arterial and venous vessels which penetrate the pancreas can give a very similar CT appearance – a previously unreported finding. This report describes the CT appearance of such defects as well as the macroscopic and microscopic analysis of the vessels penetrating the pancreas in a cadaver having this CT finding.     

螺旋CT在腕舟骨骨折诊断中的临床价值

目的探讨螺旋CT(SCT)在腕舟骨骨折诊断中的临床应用价值。方法 60例早期腕舟骨骨折患者经腕关节常规X线检查后,采用SCT进行腕关节的螺旋扫描,并在工作站上作多平面重建(MPR)及表面遮盖显示(SSD)影像后处理。60例舟骨骨折病例均按Herbert分型,并对X线平片与螺旋CT影像进行比较及综合分析。结果 60例舟骨骨折病例中,A1型4例(6.6%),A2型5例(8.3%),B1型2例(3.3%),B2型29例(48.3%),B3型15例(25%),B4型5例(8.3%),X线平片漏诊12例,此12例X线平片漏诊的骨折均经螺旋CT确诊。结论螺旋CT能够明确腕舟骨骨折的诊断,多能清晰显示X线平片难以诊断的腕舟骨隐匿性骨折;SSD和MPR成像技术能立体直观观察腕舟骨的骨折线走行及移位情况,能对腕舟骨骨折作出准确的分型,从而为临床治疗方案的拟定提供重要参考。     

急性胰腺炎的CT诊断

目的探讨CT对急性胰腺炎的诊断价值。方法回顾性分析32例经临床证实急性胰腺炎患者的CT资料,观察其CT表现特征,全部患者均经腹部CT平扫,其中6例又经增强扫描。结果急性轻症胰腺炎19例,急性重症胰腺炎13例。CT主要表现为胰腺弥漫性增大,密度降低,其中,9例有不规则低密度区,17例有胰周积液,1例胰腺内见局限性斑点状高密度出血影。结论 CT检查是诊断急性胰腺炎及其并发症的重要方法。     

急性胰腺炎侵及胃裸区的CT表现

目的 :探讨急性胰腺炎 (acutepancreatitis ,AP)胃裸区受累CT表现特征 ,与毗邻结构受累的关系。材料和方法 :对15 8例AP患者行螺旋CT增强或平扫 ,观察胃裸区受累CT表现特征和受累发生率 ,与毗邻结构受累的关系。结果 :胃裸区受累发生率为 75 .9% ,表现为小点条状、小斑片状到片团状软组织密度影或伴积液。胃裸区内病变向下直接与肾旁前间隙内的胰腺周围间隙相连续 ;向左、向上与左膈下潜在脂肪间隙相连续。结论 :AP时胃裸区易受累 ,表现为不同程度的炎性改变。胃裸区向下直接与肾旁前间隙内的胰腺周围间隙相通连 ;向左、向上与左膈下潜在脂肪间隙相通连。     

Outcomes after Peripancreatic Fluid Drainage in Patients with Simultaneous Pancreas-Kidney Transplantation

PurposeTo determine the clinical outcomes of patients who underwent image-guided drainage of peripancreatic fluid collections after simultaneous pancreas-kidney (SPK) transplantation.Materials and MethodsA retrospective review of all patients who underwent peripancreatic fluid collection drainage after SPK, from January 2000 to August 2017, at a single institution was performed. Patient characteristics, surgical technique, medication regimen, microbial analysis, and clinical outcomes were reviewed. Thirty-one patients requiring a total of 41 drainages were included in this study. The median age was 44 years (range 30–58 years), and median time between SPK and drainage was 28 days (range 8 to 3,401 days). Fisher’s exact test, unpaired Student t-tests, and Pearson correlations were used for statistical analysis.ResultsFever (51%) and abdominal pain (31%) were the most common presenting symptoms. The average amount of fluid drained at the time of drain placement was 97 mL (SD 240 mL). The average time spent with a drain in place was 33 days (SD 31 days). Microorganisms were isolated in the fluid of 22 of 41 drainages (54%), with mixed gastrointestinal flora being the most common. No further intervention was needed in 34 of 41 drainages (82%). However, drainage failed in 5 of 31 patients (16%), requiring surgical intervention with removal of the pancreas transplant.ConclusionsPercutaneous drainage of peripancreatic fluid collections after SPK transplantation is a safe and effective treatment option.     

多层螺旋CT胰腺增强扫描：扫描方案的选择及对胰周血管的评价

目的：通过胰腺同层动态增强扫描,获得感兴趣区的时间-密度曲线,确定胰腺增强扫描的最佳延迟时间,并应用此扫描方案分析胰周血管的显示率。方法：①随机选择20例无胰腺疾病的患者进行胰腺同层动态增强扫描,获得感兴趣区的强化峰值及到达峰值时间;②随机选择40例无胰腺疾病的患者进行胰腺三期增强扫描,分析胰周血管的显示率。结果：①腹主动脉强化峰值时间约为30s,平均强化峰值为350．3HU,20s时平均CT值为316．7HU;门静脉强化峰值时间约为45s,胰腺实质强化峰值时间约为40s,肝脏实质强化峰值时间约为55s,曲线到达峰值后75s内处于平台期;②胰周主要动脉（CA、HA、SA、sMA）的显示率为100％（40／40）,除AIPDA以外的其它胰周小动脉显示率为75％～100％。胰周主要静脉（PV、SV、SMV）的显示率为100％（40／40）,除AIPDV以外的其它胰周小静脉显示率为75％-100％。结论：在注射剂量100ml,注射流率4ml／S时,建议多层螺旋CT胰腺增强扫描的延迟时间分别为动脉期20s,胰腺实质期45s,门静脉期或肝脏期70s。     

The revised Atlanta classification of acute pancreatitis: its importance for the radiologist and its effect on treatment

An international working group has modified the Atlanta classification for acute pancreatitis to update the terminology and provide simple functional clinical and morphologic classifications. The modifications (a) address the clinical course and severity of disease, (b) divide acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis, (c) distinguish an early phase (1st week) and a late phase (after the 1st week), and (d) emphasize systemic inflammatory response syndrome and multisystem organ failure. In the 1st week, only clinical parameters are important for treatment planning. After the 1st week, morphologic criteria defined on the basis of computed tomographic findings are combined with clinical parameters to help determine care. This revised classification introduces new terminology for pancreatic fluid collections. Depending on presence or absence of necrosis, acute collections in the first 4 weeks are called acute necrotic collections or acute peripancreatic fluid collections. Once an enhancing capsule develops, persistent acute peripancreatic fluid collections are referred to as pseudocysts; and acute necrotic collections, as walled-off necroses. All can be sterile or infected. Terms such as pancreatic abscess and intrapancreatic pseudocyst have been abandoned. The goal is for radiologists, gastroenterologists, surgeons, and pathologists to use the revised classifications to standardize imaging terminology to facilitate treatment planning and enable precise comparison of results among different departments and institutions.