Johnson C D, Stephens D H, Sarr M G
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
AJR Am J Roentgenol. 1991 Jan;156(1):93-5. doi: 10.2214/ajr.156.1.1898576.
This study was performed to determine if a correlation exists between pancreatic parenchymal enhancement or lack thereof on contrast-enhanced CT and surgical evidence of pancreatic necrosis. Accurate CT assessment of pancreatic vascular perfusion would be helpful in preoperative planning before pancreatic debridement and necrosectomy. The CT scans and medical records were blindly and retrospectively reviewed in 13 patients with the operative diagnosis of pancreatic necrosis. In all cases, CT examinations preceded surgery within 72 hr. Surgical and pathologic findings served as the gold standards for the diagnosis of pancreatic necrosis. Seven (54%) of 13 patients had a region or regions of parenchymal necrosis within the head, body, and/or tail of the pancreas seen during surgery. All seven of these patients had no pancreatic enhancement on CT in at least one region of the pancreas (CT sensitivity = 100%). In four of the seven, two regions were found to be necrotic at surgery, but only one of the two segments did not enhance on CT scans. In three of the seven patients, lack of contrast enhancement on CT (no enhancement of the pancreatic head and body in two patients and throughout the gland in another) correlated with necrosis in the same regions at surgery. The remaining six (46%) patients, who had peripancreatic or small, focal, and/or superficial areas of pancreatic necrosis at surgery, had normal pancreatic enhancement on CT. Our results show that regions of pancreatic necrosis found surgically correlate with lack of enhancement of pancreatic parenchyma on CT. Peripancreatic necrosis and minor areas of focal or superficial parenchymal necrosis were not detected on CT.
本研究旨在确定对比增强CT上胰腺实质强化情况或无强化情况与胰腺坏死的手术证据之间是否存在相关性。准确的CT评估胰腺血管灌注情况，将有助于胰腺清创术和坏死组织切除术的术前规划。对13例经手术诊断为胰腺坏死患者的CT扫描和病历进行了盲法回顾性分析。所有病例中，CT检查均在手术前72小时内进行。手术和病理结果作为诊断胰腺坏死的金标准。13例患者中有7例（54%）在手术中可见胰腺头部、体部和/或尾部存在一个或多个实质坏死区域。这7例患者在CT上胰腺至少有一个区域均无强化（CT敏感性 = 100%）。7例中有4例在手术中发现两个区域坏死，但CT扫描仅其中一个节段无强化。7例患者中有3例CT上缺乏对比剂强化（2例患者胰腺头部和体部无强化，另1例整个胰腺均无强化），与手术中相同区域的坏死情况相关。其余6例（46%）患者在手术中存在胰腺周围或小的、局灶性和/或浅表性胰腺坏死区域，其CT上胰腺强化正常。我们的结果表明，手术中发现的胰腺坏死区域与CT上胰腺实质无强化相关。CT未检测到胰腺周围坏死以及局灶性或浅表性实质坏死的小区域。
