Mortelé K J, Mergo P J, Taylor H M, Ernst M D, Ros P R
Department of Radiology, Health Science Center, University of Florida College of Medicine, Gainesville, USA.
J Comput Assist Tomogr. 2001 Jan-Feb;25(1):50-4. doi: 10.1097/00004728-200101000-00009.
The purpose of this work was to determine the prevalence and morphologic helical CT features of splenic and perisplenic involvement in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis.
One hundred fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were reviewed retrospectively and independently by three observers. CT scans were scored using the CT severity index (CTSI): Pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CTSI and the presence of splenic and perisplenic involvement was calculated (K statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using the Fisher exact test.
The severity of pancreatitis was graded as mild (n = 59 scans), moderate (n = 82 scans), and severe (n = 18 scans). Splenic and perisplenic abnormalities detected included perisplenic inflammatory fluid collections (95 scans, 58 patients), narrowing of the splenic vein (35 scans, 25 patients), splenic vein thrombosis (31 scans, 19 patients), splenic infarction (10 scans, 7 patients), and subcapsular hemorrhage (2 scans, 2 patients). No cases of splenic artery pseudoaneurysm formation, intrasplenic venous thrombosis, intrasplenic pseudocysts, or abscesses were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of abnormalities was 75.5-79.2 and 71.7-100%, respectively. A statistically significant difference between the presence of abnormalities and the severity of pancreatitis was observed (p < 0.001).
Splenic vein thrombosis (19%) and splenic infarction (7%) are relatively common CT findings in association with acute pancreatitis. The CTSI proves to be accurate in predicting these complications as there is a statistically significant correlation between the prevalence of these complications and the severity of pancreatitis.
本研究旨在确定急性胰腺炎性疾病患者脾脏及脾周受累的患病率和螺旋CT形态学特征，并与胰腺炎的严重程度相关联。
对100例连续急性胰腺炎患者的159次对比增强螺旋CT扫描进行回顾性分析，由三位观察者独立进行评估。CT扫描采用CT严重指数（CTSI）评分：胰腺炎分为轻度（0 - 2分）、中度（3 - 6分）和重度（7 - 10分）。计算观察者间在CTSI以及脾脏和脾周受累情况方面的一致性（K统计量）。使用Fisher精确检验评估并发症患病率与胰腺炎程度之间的相关性。
胰腺炎的严重程度分为轻度（n = 59次扫描）、中度（n = 82次扫描）和重度（n = 18次扫描）。检测到的脾脏和脾周异常包括脾周炎性积液（95次扫描，58例患者）、脾静脉狭窄（35次扫描，25例患者）、脾静脉血栓形成（31次扫描，19例患者）、脾梗死（10次扫描，7例患者）和包膜下出血（2次扫描，2例患者）。未检测到脾动脉假性动脉瘤形成、脾内静脉血栓形成、脾内假性囊肿或脓肿病例。观察者间在胰腺炎程度评分和异常总体存在情况方面的一致性范围分别为75.5 - 79.2%和71.7 - 100%。观察到异常存在与胰腺炎严重程度之间存在统计学显著差异（p < 0.001）。
脾静脉血栓形成（19%）和脾梗死（7%）是与急性胰腺炎相关的相对常见的CT表现。CTSI在预测这些并发症方面被证明是准确的，因为这些并发症的患病率与胰腺炎的严重程度之间存在统计学显著相关性。
