Department of Radiology, Konkuk University Medical Center, 4-12, Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
Eur J Radiol. 2012 Aug;81(8):1728-34. doi: 10.1016/j.ejrad.2011.04.061. Epub 2011 May 17.
The purpose of this study is to evaluate the question of whether nonenhanced CT or contrast enhanced portal phase CT can replace multiphasic pancreas protocol CT in short term monitoring in patients with acute pancreatitis.
This retrospective study was approved by the Institutional Review Board. From April 2006 to May 2010, a total of 52 patients having acute pancreatitis who underwent initial dual phase multidetector row CT (unenhanced, arterial, and portal phase) at admission and a short term (within 30 days) follow up dual phase CT (mean interval 10.3 days, range 3-28 days) were included. Two abdominal radiologists performed an independent review of three sets of follow up CT images (nonenhanced scan, single portal phase scan, and dual phase scan). Interpretation of each image set was done with at least 2-week interval. Radiologists evaluated severity of acute pancreatitis with regard to pancreatic inflammation, pancreatic necrosis, and extrapancreatic complication, based on the modified CT severity index. Scores of each image set were compared using a paired t-test and interobserver agreement was evaluated using intraclass correlation coefficient statistics.
Mean scores of sum of CT severity index on nonenhanced scan, portal phase scan, and dual phase scan were 5.7, 6.6, and 6.5 for radiologist 1, and 5.0, 5.6, and 5.8 for radiologist 2, respectively. In both radiologists, contrast enhanced scan (portal phase scan and dual phase scan) showed significantly higher severity score compared with that of unenhanced scan (P<0.05), while portal phase and dual phase scan showed no significant difference each other. The trend was similar regarding pancreatic inflammation and extrapancreatic complications, in which contrast enhanced scans showed significantly higher score compared with those of unenhanced scan, while no significant difference was observed between portal phase scan and dual phase scan. In pancreatic necrosis analysis, there was no significant difference between the three image sets for both radiologists. However, when only the patients having pancreatic necrosis (n=13) was separately analyzed, significant differences were observed between the unenhanced and portal phase scan (P=0.04, for radiologist 1), or unenhanced and dual phase scan (P=0.013, for radiologist 2).
For short-term follow up imaging in assessment of patients with acute pancreatitis, single portal phase CT images without adding unenhanced or arterial phase images provide sufficient information, and thereby reduce radiation exposure.
本研究旨在探讨非增强 CT 或对比增强门静脉期 CT 是否可以替代急性胰腺炎患者的多期胰腺方案 CT 进行短期监测。
本回顾性研究经机构审查委员会批准。2006 年 4 月至 2010 年 5 月，共纳入 52 例因急性胰腺炎入院时行初始双期多层螺旋 CT（平扫、动脉期和门静脉期）检查并于 30 天内（平均间隔 10.3 天，范围 3-28 天）行短期（30 天内）双期 CT 随访的患者。两名腹部放射科医生分别独立对三组随访 CT 图像（平扫、单门静脉期扫描和双期扫描）进行了评估。根据改良 CT 严重指数对每位患者的胰腺炎症、胰腺坏死和胰腺外并发症的严重程度进行了评估。采用配对 t 检验比较各图像组的评分，并采用组内相关系数统计评估观察者间的一致性。
在两位放射科医生中，平扫、门静脉期扫描和双期扫描的 CT 严重指数总分分别为 5.7、6.6 和 6.5，分别为放射科医生 1；5.0、5.6 和 5.8，分别为放射科医生 2。在两位放射科医生中，增强扫描（门静脉期扫描和双期扫描）的严重程度评分均明显高于平扫（P<0.05），而门静脉期扫描和双期扫描之间无显著差异。在胰腺炎症和胰腺外并发症方面，增强扫描的评分明显高于平扫，而门静脉期扫描和双期扫描之间无显著差异，这种趋势类似。在胰腺坏死分析中，两位放射科医生的三组图像之间无显著差异。然而，当单独分析仅存在胰腺坏死的患者（n=13）时，平扫与门静脉期扫描（放射科医生 1，P=0.04）或平扫与双期扫描（放射科医生 2，P=0.013）之间存在显著差异。
在急性胰腺炎患者的短期随访成像中，不增加平扫或动脉期图像的单门静脉期 CT 图像可提供足够的信息，从而减少辐射暴露。
