| 摘要: |
| 目的:探讨磁共振T2WI压脂序列对于急性胰腺炎患者合并肝功能损伤的诊断价值。方法:回顾性分析2019年1月—2023年1月就诊于天津市南开医院的134例急性胰腺炎患者的腹部MRI影像及临床资料。根据实验室肝功能检查，包括谷丙转氨酶(ALT)、总胆红素(TBIL)、白蛋白(ALB)将入组患者分为肝功能损伤组(n=90)及肝功能正常组(n=44)，分析所有患者的腹部MRI影像征象，记录肝脏水肿、门静脉周围淋巴水肿、胆囊壁水肿的出现频数，并根据分组以生化检查为金标准绘制三种征象的独立及联合诊断胰腺炎合并肝功能损伤的受试者工作特征(ROC)曲线，通过比较ROC曲线下面积(AUC)，阐明三种MRI征象(肝脏水肿、胆囊壁水肿、门静脉周围淋巴水肿)对急性胰腺炎合并肝功能损伤的诊断价值。结果:肝功能损伤组的炎症指标尿淀粉酶及C反应蛋白明显高于肝功能正常组(P <0.05)。肝脏水肿、门静脉周围淋巴水肿、胆囊壁水肿三种肝损伤MRI征象的评估具有较高的观察者间及观察者内一致性(κ＞0.8)，其诊断胰腺炎合并肝损害伤的AUC值分别为0.67、0.65、0.67，其敏感度分别为0.41、0.34、0.39，特异度分别为0.93、0.95、0.95。肝脏水肿+胆囊壁水肿+门静脉周围淋巴水肿联合三者联合诊断AUC提高至0.82，敏感度为0.76，特异度为0.89。结论:联合T2WI压脂序列上肝脏水肿、门静脉周围淋巴水肿、胆囊壁水肿的影像特征，可提高肝功能损伤的诊断效能，为急性胰腺炎患出现肝功能损伤的提供预防和诊治依据。 |
| 关键词: 急性胰腺炎 肝功能损伤 核磁共振 谷丙转氨酶 |
| DOI：10.3969/j.issn.1007-6948.2024.06.023 |
| 投稿时间：2024-02-18 |
| 基金项目: |
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| The value of T2WI-fat-suppression sequence in diagnosis acute pancreatitis-associated liver injury |
| LI Si-cong,GONG Yan,ZHANG Xiang |
| Department of Radiology, Tianjin Nankai Hospital, TianJin300100,China |
| Abstract: |
| Objective To evaluate the diagnostic value of magnetic resonance imaging (MRI) T2WI-fat-suppression sequence for acute pancreatitis-associated liver injury. Methods A retrospective analysis was performed on 134 patients with acute pancreatitis who underwent MRI examination for the first time in Tianjin Nankai Hospital from January 2019 to January 2023. According to laboratory information of liver function, including ALT alanine aminotransferase (ALT), total bilirubin (TBIL), and albumin (ALB), the enrolled patients were divided into liver function injury group(n=90) and liver function normal group(n=44). The abdominal MRI imaging signs of all patients were analyzed, and the frequency of liver edema, periportal oedema and gallbladder wall edema was recorded. The independent and combined receiver operating characteristic (ROC) curves of three signs were drawn based on biochemical examination as the golden standard according to grouping. By comparing the area under the ROC curve (AUC), the diagnostic value of the three MRI signs(liver edema, periportal lymphedema, and gallbladder wall edema) for acute pancreatitis-associated liver function injury was elucidated. Results Liver function injury group's inflammatory index amylase and C-reflection protein were significantly higher than liver function normal group(P <0.05). The interobserver and intraobserver agreement of liver edema, periportal lymphedema, and gallbladder wall edema were high in diagnosing pancreatitis-associated liver injury(κ＞0.8). The AUC values of liver edema, periportal lymphedema, and gallbladder wall edema in diagnosing pancreatitis-associated liver injury were 0.67, 0.65, 0.67, respectively, their sensitivity were 0.41, 0.34, 0.39, specificity were 0.93, 0.95, 0.95. The AUC, sensitivity for the liver edema+ periportal lymphedema+gallbladder wall edema combined diagnosis of pancreatitis-associated liver injury were improved to 0.82, the sensitivity were 0.76,and the specificity were 0.89. Conclusion T2WI-fat-suppression sequence can be used as an effective means to evaluate whether patients with acute pancreatitis are complicated with liver injury. Combined MRI features of liver edema, periportal oedema, and gallbladder wall edema can improved the diagnostic efficiency and provide prevention and treatment basis for patients with acute pancreatitis-associated liver injury. |
| Key words: Acute pancreatitis liver injury magnetic resonance imaging alanine aminotransferase |
