Jiang Zhi-Qiong, Xiao Bo, Zhang Xiao-Ming, Xu Hai-Bo
Department of Geratology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Department of Radiology, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China.
Quant Imaging Med Surg. 2021 May;11(5):1909-1920. doi: 10.21037/qims-20-280.
Although a number of studies have reported on the vascular abnormalities detected by magnetic resonance imaging (MRI) in patients with late-phase acute pancreatitis (AP), few have studied those occurring in the early phase of the disease. The aim of this research was to investigate the MRI findings of early vascular abnormalities in AP and to analyze the correlation of the prevalence of vascular involvement with the severity of AP based on the MR severity index (MRSI) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores.
A retrospective analysis was conducted of 301 consecutive AP patients who were admitted to our institution between March 2013 and June 2019. All patients underwent initial MRI during the early phase of pancreatitis and one or more repeat MRI scans in the late phase. Peripancreatic vascular conditions and pancreatitis were assessed using T1-/T2-weighted imaging and dynamic-enhanced MRI. The association between the prevalence of vascular involvement and AP severity graded according to the MRSI or APACHE II score was analyzed using Spearman's rank correlation.
Among 301 AP patients, 75 (24.9%) had at least one MRI-detected vascular abnormality. Overall, vascular involvement on MRI was higher in necrotizing pancreatitis than in edematous pancreatitis [43.2% (54/125) 11.9% (21/176), χ=38.2, P<0.001]. In the early phase of AP, the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis was 24.9% (75/301), 22.3% (67/301), and 19.9% (60/301), respectively. Splenic vein phlebitis was seen on initial MRI in 55.6% (15/27) of patients who had splenic vein thrombosis on repeat MRI. The MRSI scores showed that the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis, respectively, was correlated with the severity of pancreatitis (r=0.532, 0.487, and 0.456; all P<0.01). The APACHE II scores showed that the prevalence of MRI-detected vascular involvement was significantly correlated with AP severity (r=0.335, P<0.05).
Vascular abnormalities, including splenic vein phlebitis and splenic arterial arteritis, are commonly seen on MRI in patients with early-phase AP, and they may be supplementary indicators that can reflect the severity of pancreatitis.
尽管多项研究报道了磁共振成像（MRI）检测到的晚期急性胰腺炎（AP）患者的血管异常情况，但很少有研究关注疾病早期出现的血管异常。本研究的目的是调查AP早期血管异常的MRI表现，并基于磁共振严重程度指数（MRSI）和急性生理与慢性健康状况评估（APACHE）II评分分析血管受累发生率与AP严重程度的相关性。
对2013年3月至2019年6月期间连续收治入我院的301例AP患者进行回顾性分析。所有患者在胰腺炎早期接受了首次MRI检查，并在晚期进行了一次或多次重复MRI扫描。使用T1加权/T2加权成像和动态增强MRI评估胰腺周围血管状况和胰腺炎情况。采用Spearman等级相关性分析血管受累发生率与根据MRSI或APACHE II评分分级的AP严重程度之间的关联。
在301例AP患者中，75例（24.9%）至少有一项MRI检测到的血管异常。总体而言，坏死性胰腺炎患者MRI上的血管受累情况高于水肿性胰腺炎患者[43.2%（54/125）对11.9%（21/176），χ²=38.2，P<0.001]。在AP早期，脾静脉炎、门静脉炎和脾动脉炎的发生率分别为24.9%（75/301）、22.3%（67/301）和19.9%（60/301）。在重复MRI检查发现脾静脉血栓形成的患者中，55.6%（15/27）在首次MRI检查时可见脾静脉炎。MRSI评分显示，脾静脉炎、门静脉炎和脾动脉炎的发生率分别与胰腺炎严重程度相关（r=0.532、0.487和0.456；均P<0.01）。APACHE II评分显示，MRI检测到的血管受累发生率与AP严重程度显著相关（r=0.335，P<0.05）。
包括脾静脉炎和脾动脉炎在内的血管异常在AP早期患者的MRI上常见，它们可能是反映胰腺炎严重程度的补充指标。
