Finkelmeier Fabian, Sturm Christian, Friedrich-Rust Mireen, Bojunga Jörg, Sarrazin Christoph, Tal Andrea, Hausmann Johannes, Zeuzem Stefan, Zangos Stephan, Albert Jörg, Farnik Harald
From the *Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe-Universität; †Institut für diagnostische und interventionelle Radiologie, Goethe-Universität, Frankfurt/Main; ‡Zentrum 4, Institut für Radiologie, Alb-Fils Kliniken, Göppingen; and §Gastroenterologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
Pancreas. 2017 Sep;46(8):1039-1045. doi: 10.1097/MPA.0000000000000881.
Choosing the best treatment option at the optimal point of time for patients with walled-off necrosis (WON) is crucial. We aimed to identify imaging parameters and clinical findings predicting the need of necrosectomy in patients with WON.
All patients with endoscopically diagnosed WON and pseudocyst were retrospectively identified. Post hoc analysis of pre-interventional contrast-enhanced computed tomography was performed for factors predicting the need of necrosectomy.
Sixty-five patients were included in this study. Forty patients (61.5%) were diagnosed with pseudocyst and 25 patients (38.5%) with WON. Patients with WON mostly had acute pancreatitis with biliary cause compared with more chronic pancreatitis and toxic cause in pseudocyst group (P = 0.002 and P = 0.004, respectively). Logistic regression revealed diabetes as a risk factor for WON. Computed tomography scans revealed 4.62% (n = 3) patients as false positive and 24.6% (n = 16) as false negative findings for WON. Reduced perfusion and detection of solid findings were independent risk factors for WON.
Computed tomography scans are of low diagnostic yield when needed to predict treatment of patients with pancreatic cysts. Reduced pancreatic perfusion and solid findings seem to be a risk factor for WON, whereas patients with diabetes seem to be at higher risk of developing WON.
为壁性坏死（WON）患者在最佳时间点选择最佳治疗方案至关重要。我们旨在确定预测WON患者是否需要进行坏死组织清除术的影像学参数和临床发现。
对所有经内镜诊断为WON和假性囊肿的患者进行回顾性识别。对干预前的对比增强计算机断层扫描进行事后分析，以寻找预测坏死组织清除术需求的因素。
本研究纳入了65例患者。40例（61.5%）被诊断为假性囊肿，25例（38.5%）被诊断为WON。与假性囊肿组更多为慢性胰腺炎和中毒性病因相比，WON患者大多患有胆源性急性胰腺炎（分别为P = 0.002和P = 0.004）。逻辑回归显示糖尿病是WON的一个危险因素。计算机断层扫描显示，有4.62%（n = 3）的患者WON诊断为假阳性，24.6%（n = 16）为假阴性。灌注减少和实性表现的检测是WON的独立危险因素。
在预测胰腺囊肿患者的治疗时，计算机断层扫描的诊断准确率较低。胰腺灌注减少和实性表现似乎是WON的危险因素，而糖尿病患者似乎发生WON的风险更高。
