Raghuwanshi Sameer, Gupta Rajesh, Vyas Mahendra Mohan, Sharma Rakesh
Assistant Professor, Department of Radio Diagnosis, People's College of Medical Science and Research Centre , Bhanpur, Bhopal, M.P., India .
Associate professor, Department of Radio Diagnosis, People's College of Medical Science and Research Centre , Bhanpur, Bhopal, M.P., India .
J Clin Diagn Res. 2016 Jun;10(6):TC06-11. doi: 10.7860/JCDR/2016/19849.7934. Epub 2016 Jun 1.
Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications.
To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index.
A prospective study of 50 cases was carried out in the Department of Radio Diagnosis, with complaint suggestive of acute pancreatitis on the basis of clinical/laboratory/ultrasonography findings were evaluated in Siemens somatom 40 slice CT. The severity of pancreatitis was scored using CT severity index, modified severity index and revised Atlanta classification and classified into mild, moderate, severe categories. Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay, Need for surgery or percutaneous intervention, Evidence of infection in any organ system, Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system, death. The clinical outcome was compared with the currently accepted Balthazar's CTSI and Modified Mortele's CTSI and revised Atlanta classification in all the cases.
Gall stone disease was most common aetiological factor seen in 40% cases, it was more common in females than males. Alcohol was second most common aetiological factor seen in 38% cases and was noted only in males. Pleural effusion was the most common extra-pancreatic complication seen in 46% cases. Balthazar grade C was the most common (40%) followed by grade D and E (25% each). Acute peri-pancreatic collection was the most common findings seen in 72% cases. Majority of the cases (42%) were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases (44%) were categorized as severe pancreatitis according modified CTSI. Majority of the cases were categorized as mild pancreatitis according revised Atlanta classification. Organ system failure, death were more seen in severe grade in modified CTSI and revised Atlanta classification.
Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Scores obtained with the modified Mortele index, show a stronger statistical correlation for all clinical outcome parameters in all the patients better than the Balthazar index.
胰腺炎是所有腹部疾病中最复杂且临床挑战最大的疾病之一。超声检查（USG）和腹部计算机断层扫描（CT）是评估胰腺时最常用的诊断成像方式。计算机断层扫描（CT）在诊断以及显示病变范围方面比超声检查更为准确和敏感。对急性胰腺炎的病因和严重程度进行早期评估对于及时治疗和密切监测重症患者至关重要。CT是评估急性胰腺炎范围和评估并发症的首选成像方法。
基于CT严重程度指数评估急性胰腺炎的预后相关性和临床结局。
在放射诊断科对50例患者进行了一项前瞻性研究，这些患者根据临床/实验室/超声检查结果提示有急性胰腺炎，在西门子somatom 40层CT上进行评估。使用CT严重程度指数、改良严重程度指数和修订的亚特兰大分类法对胰腺炎的严重程度进行评分，并分为轻度、中度、重度类别。根据以下参数对患者进行临床随访：住院时间、是否需要手术或经皮介入、任何器官系统是否有感染迹象、器官衰竭的发生情况（呼吸系统、心血管系统、肾脏、肝脏和血液系统）、死亡情况。在所有病例中，将临床结局与目前公认的巴尔萨泽CT严重程度指数（CTSI）、改良的莫尔特勒CTSI以及修订的亚特兰大分类法进行比较。
胆结石病是最常见的病因，在40%的病例中可见，女性比男性更常见。酒精是第二常见的病因，在38%的病例中可见，且仅见于男性。胸腔积液是最常见的胰腺外并发症，在46%的病例中可见。巴尔萨泽C级是最常见的（40%），其次是D级和E级（各25%）。急性胰周积液是最常见的表现，在72%的病例中可见。根据巴尔萨泽CTSI评分，大多数病例（42%）被归类为轻度胰腺炎。根据改良CTSI，大多数病例（44%）被归类为重度胰腺炎。根据修订的亚特兰大分类法，大多数病例被归类为轻度胰腺炎。在改良CTSI和修订的亚特兰大分类法中，重度分级的病例中器官系统衰竭、死亡更为常见。
改良的CT严重程度指数使评分更容易计算，并减少了观察者之间的差异。与巴尔萨泽指数相比，使用改良的莫尔特勒指数获得的评分在所有患者的所有临床结局参数上显示出更强的统计学相关性。
