Diagnostic value of abdominal color Doppler flow imaging and CT in acute pancreatitis
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摘要:
目的探讨腹部彩色多普勒超声（CDFI）与CT对急性胰腺炎诊断价值。 方法回顾性分析2013年1月~2020年6月在本院就诊的81例急性胰腺炎患者的病例资料。将入组患者CDFI与CT检查结果进行比较，探讨CDFI、CT在急性胰腺炎患者诊断中的影像学特征，比较二者对急性胰腺炎的诊断准确率，及其对水肿型、坏死出血型胰腺炎的分类诊断价值。 结果总结81例急性胰腺炎患者CT、CDFI检查的影像学特征，发现CDFI检查检出胰管扩张率25.93%高于CT检查的12.35%，CDFI检出胰内小灶液化、胰外片状高密度率均为12.35%，分别低于CT检查的30.86%、27.16%，差异有统计学意义（P < 0.05）；两种检查方式对胰外脓肿、胆总管结石、脂肪层模糊、实质不均的检出率比较，差异无统计学意义（P>0.05）。以临床综合诊断结果为金标准，CDFI检查漏诊16例、CT检查漏诊9例，CDFI、CT对急性胰腺炎的诊断符合率分别为80.25%（65/81）、88.89%（72/81），差异无统计学意义（P>0.05）。CDFI对水肿型胰腺炎、坏死出血型胰腺炎的诊断符合率分别为78.79%、86.67%与CT检查87.88%、93.33%比较，差异无统计学意义（P>0.05）。 结论腹部CDFI可以为急性胰腺炎患者提供较为准确的判断，对胰管扩张的判断上具有天然优势，可以作为临床诊治的首选检查方式之一。 Abstract:ObjectiveTo explore the diagnostic value of color Doppler flow imaging (CDFI) and CT for acute pancreatitis. Methods81 patients with acute pancreatitis admitted in the hospital from January 2013 to June 2020 were retrospectively analyzed. The examination results of CDFI and CT were compared among patients. The imaging features of CDFI and CT were explored in the diagnosis of acute pancreatitis patents. The diagnostic accuracy rate of acute pancreatitis, and diagnostic valu by the two methods were compared in oedematous and necrotic hemorrhagic pancreatitis. ResultsBy summarizing the imaging features of CT and CDFI in 81 patients with acute pancreatitis, The results showed that the expansion rate of pancreatic duct was 25.93% higher than that of CT 12.35%. The rates of small intrapancreatic liquefaction and extrapancreatic high density detected by CDFI were 12.35%, which were lower than 30.86% and 27.16% of CT examination respectively, and the difference was statistically significant (P < 0.05). There were no significant differences in the detection rates of extrapancreatic abscess, common bile duct stones (CBDS), fat layer blur and parenchyma unevenness between the two examination methods (P>0.05). Taking the clinical comprehensive diagnosis results as the gold standard, CDFI missed 16 cases diagnosis and CT missed 9 cases. The diagnostic coincidence rates of CDFI and CT for acute pancreatitis were 80.25% (65/81) and 88.89% (72/81), respectively, with no significant difference (P>0.05). The diagnostic coincidence rates of CDFI for oedematous pancreatitis and necrotic hemorrhagic pancreatitis were 78.79% and 86.67%, without significant difference compared with those of CT (87.88%, 93.33%) (P>0.05). ConclusionAbdominal CDFI can provide more accurate judgment for patients with acute pancreatitis. It has natural advantages in the judgment of pancreatic duct dilatation, and can be applied as one of the first choice for clinical diagnosis and treatment. -
Key words:
- Acute pancreatitis /
- Color Doppler flow imaging /
- CT /
- Clinical value
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图 1 水肿型、坏死出血型胰腺炎患者的CT、CDFI图像
A~B:患者男，52岁，确诊为水肿型胰腺炎；A: CDFI图像可见胰腺呈弥漫性增大、边缘清晰、形态较规则; B: CT图可见胰腺呈均匀性强化、肿大; C~D:患者女, 50岁, 确诊为坏死出血型胰腺炎; C: CDFI图像可见胰周有渗出液、胰腺形态不规则、边缘欠清晰、内部呈强回声; D: CT图可见胰腺内部出现低密度灶, 轮廓不清晰.
Figure 1. CT and CDFI images of patients with oedematous and necrotic hemorrhagic pancreatitis.
表 1 急性胰腺炎患者CT、CDFI检查的影像学特征[n=81, n(%)]
Table 1. Imaging features of CT and CDFI in patients with acute pancreatitis
检查方法 胰外脓肿 胆总管结石 胰内小灶液化 脂肪层模糊 实质不均 胰管扩张 胰外片状高密度 CDFI 12(14.81) 7(8.64) 10(12.35) 13(16.05) 20(24.69) 2(25.93) 10(12.35) CT 15(18.52) 3(3.70) 25(30.86) 10(12.35) 19(23.46) 10(12.35) 22(27.16) χ2 0.400 1.705 8.200 0.456 0.034 4.827 5.608 P 0.527 0.192 0.004 0.499 0.854 0.028 0.018 
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表 2 急性胰腺炎患者CT、CDFI检查诊断符合率比较[n=81, n(%)]
Table 2. Comparison on diagnostic coincidence rates of CT and CDFI in patients with acute pancreatitis
检查方法 水肿型胰腺炎(n=66) 坏死出血型胰腺炎(n=15) 合计 CDFI 52(78.79) 13(86.67) 65(80.25) CT 58(87.88) 14(93.33) 72(88.89) χ2 1.964 0.370 2.318 P 0.161 0.543 0.128
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