急性坏死性胰腺炎并胰管中断综合征的MRI表现

摘要

Objective To investigate MRI features of disconnected pancreatic duct syndrome caused by acute necrotizing pancreatitis. Methods 26 patients (15 men, 11 women, mean age:50.2±15.2 years) with acute necrotizing pancreatitis and discon-nected pancreatic duct syndrome confirmed by surgery from January 2010 to January 2016 were included in the retrospective study. The initial MRI at 3-10 days after the onset of acute necrotizing pancreatitis was analyzed for location, depth, and type of necrosis and MRSI scores. The display rate of disconnected pancreatic duct as well as the relationship between disconnected pancreatic duct and walled-off necrosis were assessed on preoperative MRI examinations. Results On the initial MRI, the depth of pancreatic necrosis was 2.4±0.3 cm (2.0-3.2 cm) involving>50％(61.5％, 16/26) or 30％-50％(38.5％, 10/26) of the pancreas with MRSI score of 8.9 ±0.9 (8.0-10.0) in the patients with transmural (65.4％, 17/26) and thick-layer (34.6％, 9/26) pancreatic necrosis. The direct sign of dis-connected pancreatic duct syndrome was seen on preoperative MRI in 19/26 (73.1％) patients within the body (57.9％, 11/19), junction of body and tail (26.3％, 5/19), or neck (15.8％, 3/19) of the pancreas. Pancreatic walled-off necrosis was found in all patients. The main pancreatic duct within the upstream pancreatic tissue was communicated with the walled-off necrosis like"apple shaped handle"in all 19 patients. Conclusion MRI features of acute necrotizing pancreatitis with disconnected pancreatic duct syndrome include thick-layer or transmural necrosis of pancreas, pancreatic duct disruption, and pancreatic walled-off necrosis.%目的 探讨急性坏死性胰腺炎所致胰管中断综合征的MRI特征.方法 回顾性分析本院从2010年1月～2016年1月间急性胰腺炎住院病例因局部并发症行外科手术证实胰管中断的患者,均于发病后3～10 d行MRI检查且术前MRI检查.分析首次MRI检查上是否存在胰腺坏死,统计胰腺坏死部位、范围、深度、类型及MRSI评分;评价复查MRI上主胰管中断显示率、中断位置及与胰腺包裹性坏死的关系.结果 共纳入胰管中断综合征患者26例(男15例,女11例,年龄50.2±15.2岁)进入研究,首次MRI检查均为急性坏死性胰腺炎,透壁性胰腺坏死占65.4％(17/26)、厚层性胰腺坏死占34.6％(9/26);胰腺内坏死厚度为2.4±0.3 cm(2～3.2 cm),坏死范围:>50％者占61.5％(16/26)、30％～50％者占38.5％(10/26),MRSI评分为8.9±0.9分(8～10分).MRI复查示73.1％(19/26)的患者见主胰管中断综合征的直接征象,即胰体部中断者占57.9％(11/19)、胰体尾交界区中断者占26.3％(5/19)、胰颈部中断者占15.8％(3/19).所有病例均见胰腺包裹性坏死形成,19例患者上游胰腺组织内的主胰管如"苹果柄"状近直角汇入病灶并相通.结论 急性胰腺炎厚层性/透壁性胰腺坏死致胰管中断综合征具有相应的MRI征象,后期出现的胰腺包裹性坏死为胰管中断综合征的并发症,可视为"厚层性/透壁性胰腺坏死-胰管中断-胰腺包裹性坏死"三部曲.