Pieńkowska Joanna, Gwoździewicz Katarzyna, Skrobisz-Balandowska Katarzyna, Marek Iwona, Kostro Justyna, Szurowska Edyta, Studniarek Michał
II Department of Radiology-Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
I Department of Radiology-Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
PLoS One. 2016 Jan 19;11(1):e0146965. doi: 10.1371/journal.pone.0146965. eCollection 2016.
Severe acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.
79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4-6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.
Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.
CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.
重症急性胰腺炎（AP）仍是一个严重的临床问题，其死亡率很高。本研究的目的是评估在AP症状出现第一天进行的CT区域灌注测量对评估发生重症急性胰腺炎风险的预后价值。
79例有临床症状且生化指标符合急性胰腺炎（急性上腹部疼痛、血清淀粉酶和脂肪酶水平升高）的患者在症状出现后24小时内接受了灌注CT检查。4-6天后进行随访检查以检测疾病进展。将41例发展为重症AP（胰腺和/或胰周组织坏死）患者的灌注参数与38例AP病程较轻的连续患者的参数进行比较。计算胰腺三个解剖分区（头、体、尾）的血流量、血容量、平均通过时间和通透表面积乘积。同时，通过急性生理与慢性健康状况评分系统（APACHE II）评估患者的临床状态，并比较实验室参数，如C反应蛋白（CRP）、血清脂肪酶和淀粉酶、谷草转氨酶（AST）、谷丙转氨酶（ALT）、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）和胆红素。
显示了轻症和重症AP患者组之间灌注参数的统计学差异。发生重症急性胰腺炎且因胰腺缺血出现胰腺和/或胰周坏死的患者，其血流量、血容量和平均通过时间显著降低，而通透表面积乘积显著升高。在使用APACHE II评分和实验室检查评估的入院时胰腺炎严重程度方面，两组之间没有统计学显著差异。
CT灌注是预测和选择急性胰腺炎早期有发生胰腺和/或胰周坏死风险患者的非常有用的指标，可用于急性胰腺炎的治疗规划和治疗监测。基于临床状态评分和实验室检查对可能的胰腺坏死进行早期怀疑，其预测价值较低。
