Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada.
Abdominal Imaging Division, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA.
Can Assoc Radiol J. 2020 Aug;71(3):344-351. doi: 10.1177/0846537119888383. Epub 2020 Jan 31.
Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented.
Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma.
After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%.
There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.
尽管已有多篇关于影像学在急性钝性胰腺外伤中价值的报告，但超声（US）、计算机断层扫描（CT）和磁共振成像（MRI）的报告表现仍存在较大差异。本研究旨在对这些影像学在急性钝性胰腺外伤评估中的应用进行系统评价。此外，还将简要介绍胰腺外伤的各种征象。
在 MEDLINE、EMBASE 和 Web of Science 数据库中进行了关键词搜索，以获取过去 20 年（1999 年以后）的相关研究。筛选标题和摘要，然后进行全文筛选。纳入标准定义为报告影像学方式（US、CT 或 MRI）在检测钝性胰腺外伤中的有效性的研究。
最初搜索了 743 项研究，最终有 37 项研究纳入了最终总结。36 项研究为回顾性研究。21 项研究的主要研究目标为胰腺损伤。相关研究人群从 5 例到 299 例不等。17 项研究将影像学结果与术中结果进行了比较。7 项研究分别对胰管损伤进行了单独分析，9 项研究仅研究了胰管损伤。CT 检测胰腺损伤的报告敏感性为 33%至 100%，特异性为 62%至 100%。US 的敏感性为 27%至 96%。只有 1 项研究报告了 MRI 的敏感性，为 92%。
目前关于初始影像学方式在钝性胰腺损伤中的准确性的报道研究之间存在较大的异质性。尽管成像设备的技术进步有望提高准确性，但目前的文献仍存在较大分歧。未来的研究需要利用最先进的成像设备，并适当定义金标准和结果衡量标准。
