Garg Mandeep, Sandhu Manavjit, Sood Bimal, Lal Anupam, Suri Sudha, Bhasin Deepak
Department of Radiodiagnosis, Postgradute Institute of Medical Education and Research, Chandigarh, India.
Australas Radiol. 2004 Jun;48(2):117-22. doi: 10.1111/j.1440-1673.2004.01270.x.
To evaluate the role of tissue harmonic imaging (THI) in acute pancreatitis, and to compare its findings with conventional grey-scale sonography and contrast-enhanced computed tomography (CECT) scan, we evaluated 25 patients diagnosed with acute pancreatitis on clinical examination and laboratory findings. Conventional grey-scale ultrasound followed by tissue harmonic sonography was done on the same machine followed by a CECT within 12 h of the ultrasound examination. The present study showed that sonograms obtained with THI were of much better quality than those obtained conventionally, especially for the pancreatic tail. The benefits of harmonic imaging were more apparent in obese patients and in others whose body habitus was unfavourable for sonography. In the assessment of pancreatic image quality, grey-scale imaging had an accuracy of 60, 80 and 28% in relation to the head, body and tail, respectively. In comparison, THI had a far higher accuracy of 80, 92 and 60% in relation to the head, body and tail, respectively, with the superiority being most obvious in the pancreatic tail region. There were no cases in which tissue harmonic sonography provided less information than conventional sonography. However, CECT scan remained the best modality in all patients for the evaluation of acute pancreatitis. It showed superior demonstration of all the morphological changes, ranging from minimal pancreatic oedema to extensive fluid collections, necrosis and the haemorrhage that developed in fulminant severe pancreatitis. Our experience thus suggests that THI cannot replace CT scan as the gold standard in the assessment of acute pancreatitis, as it is poor in evaluating the pancreatic tail, cannot clearly distinguish phlegmon from necrosis, and is inferior to CT in the assessment of the complications of acute pancreatitis.
为评估组织谐波成像（THI）在急性胰腺炎中的作用，并将其检查结果与传统灰阶超声及对比增强计算机断层扫描（CECT）进行比较，我们对25例经临床检查及实验室检查确诊为急性胰腺炎的患者进行了评估。在同一台机器上先进行传统灰阶超声检查，随后进行组织谐波超声检查，并在超声检查后12小时内进行CECT检查。本研究表明，THI获得的超声图像质量比传统方法获得的图像质量好得多，尤其是对于胰腺尾部。谐波成像的优势在肥胖患者及其他体型不利于超声检查的患者中更为明显。在评估胰腺图像质量方面，灰阶成像对胰头、胰体和胰尾的准确率分别为60%、80%和28%。相比之下，THI对胰头、胰体和胰尾的准确率分别为80%、92%和60%，远高于灰阶成像，在胰腺尾部区域优势最为明显。没有出现组织谐波超声提供的信息比传统超声少的情况。然而，CECT扫描仍是评估所有患者急性胰腺炎的最佳方式。它能更好地显示从轻微胰腺水肿到广泛液体聚集、坏死以及暴发性重症胰腺炎中出现的出血等所有形态学变化。因此，我们的经验表明，THI不能取代CT扫描作为评估急性胰腺炎的金标准，因为它在评估胰腺尾部方面较差，无法清晰区分蜂窝织炎与坏死，且在评估急性胰腺炎并发症方面不如CT。
