应用自旋回波平面成像磁共振弹性成像技术对急性胰腺炎进行早期诊断和严重程度评估。
Early diagnosis and severity assessment of acute pancreatitis (AP) using MR elastography (MRE) with spin-echo echo-planar imaging.
机构信息
Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
Department of Hepato-pancreato-biliary Tumour Surgery, Shengjing Hospital of China Medical University, Shenyang, P.R. China.
出版信息
J Magn Reson Imaging. 2017 Nov;46(5):1311-1319. doi: 10.1002/jmri.25679. Epub 2017 Mar 2.
PURPOSE
To evaluate the accuracy of magnetic resonance elastography (MRE) in comparison to contrast-enhanced computed tomography (CE-CT) for early diagnosis and prediction of severity in acute pancreatitis (AP).
MATERIALS AND METHODS
This cross-sectional prospective study included 76 patients with suspected AP who underwent both CE-CT and 3.0T MRE within 24 hours of hospital admission. Pancreatic stiffness, CT severity index (CTSI), Acute Physiology and Chronic Health Evaluation (APACHE)-II, and Bedside Index for Severity in AP (BISAP) scores were comparatively evaluated using data from the first 24 hours of admission, and diagnosis and severity of AP were confirmed according to the revised Atlanta Classification (2012). The accuracy of MRE for predicting disease severity was compared with that of CE-CT and the clinical scoring systems using area under the receiver-operating curve (AUC) analysis.
RESULTS
AP was confirmed in 56/76 patients (73.7%). Pancreatic stiffness values of >1.47 kPa showed significantly better diagnostic performance than CE-CT (AUC: 0.993 vs. 0.818, P < 0.001) along with greater sensitivity (96.4% vs. 78.6%, P = 0.006) and accuracy (96.1% vs. 81.6%, P = 0.007). Ten patients (10/76; 13.2%) had clinically severe AP. The accuracy of pancreatic stiffness >2.47 kPa was comparable to that of the CTSI, APACHE-II and BISAP scores for predicting severe AP (accuracy = 85.5%, 75.0%, 88.2%, and 78.9%, respectively). The pairwise comparisons were not significant after Bonferroni correction (P < 0.008 [0.05/6]), with P values of 0.008 (MRE vs. CTSI), 0.823 (MRE vs. APACHE-II) and 0.414 (MRE vs. BISAP).
CONCLUSION
Early MRE is a useful, noninvasive method for both diagnosis and early severity assessment of AP. We recommend MRE at hospital admission for initial evaluation of AP.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1311-1319.
目的
评估磁共振弹性成像（MRE）与对比增强 CT（CE-CT）在急性胰腺炎（AP）早期诊断和严重程度预测方面的准确性。
材料与方法
本研究为前瞻性横断面研究，共纳入 76 例疑似 AP 患者，于入院 24 小时内行 CE-CT 和 3.0T MRE 检查。对比入院第 1 天的临床资料，评估胰腺硬度、CT 严重指数（CTSI）、急性生理学与慢性健康状况评分系统Ⅱ（APACHE-Ⅱ）和床边严重程度指数（BISAP）评分，根据修订版亚特兰大分类（2012 年）诊断和评估 AP 的严重程度。采用受试者工作特征曲线（ROC）下面积（AUC）分析比较 MRE 预测疾病严重程度的准确性，并与 CE-CT 和临床评分系统进行比较。
结果
76 例患者中 56 例（73.7%）确诊为 AP。胰腺硬度值＞1.47kPa 比 CE-CT 具有更好的诊断性能（AUC：0.993比 0.818，P＜0.001），同时具有更高的灵敏度（96.4%比 78.6%，P=0.006）和准确性（96.1%比 81.6%，P=0.007）。10 例患者（10/76；13.2%）发生临床重度 AP。胰腺硬度＞2.47kPa 预测重度 AP 的准确性与 CTSI、APACHE-Ⅱ和 BISAP 评分相当（准确性分别为 85.5%、75.0%、88.2%和 78.9%）。Bonferroni 校正后两两比较差异无统计学意义（P＜0.008[0.05/6]），校正后 P 值分别为 0.008（MRE 比 CTSI）、0.823（MRE 比 APACHE-Ⅱ）和 0.414（MRE 比 BISAP）。
结论
早期 MRE 是一种有用的、非侵入性的 AP 诊断和早期严重程度评估方法。我们建议将 MRE 用于 AP 的初始评估。
证据水平
1 技术疗效：Ⅱ级。J. 磁共振成像 2017；46：1311-1319。
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