彩色超声与超声造影诊断急性胰腺炎脾静脉并发症的对比研究

蔡迪明; 罗燕; 李永忠等

彩色超声与超声造影诊断急性胰腺炎脾静脉并发症的对比研究

Assessing Splenic Vein Complicationsin Patients with Acute Pancreatitis Using Color Doppler Ultrasound and Contrast Enhanced Ultrasound

摘要

摘要: 目的探讨急性胰腺炎（acute pancreatitis, AP）发生脾静脉并发症(splenic vein complications, SVCs)时，常规彩色超声(color Doppler flow imaging, CDFI)与超声造影(contrast enhanced ultrasonography, CEUS)对脾脏并发症诊断效能的对比研究。方法收集2012年1月至2013年4月间，我院住院的AP患者 144例（男性86例，女性58例），年龄（44.3±11.9）岁，分别进行CDFI、CEUS以及上腹部增强CT(contrast enhanced computer tomography, CECT)检查（CT与超声的检查间隔小于72 h）。以CECT结果作为金标准，比较CDFI和CEUS对于诊断AP发生SVCs的诊断效能，对结果进行受试者工作特征曲线（ROC曲线）分析，分别计算CDFI、CEUS各自的曲线下面积（AUC）、敏感性、特异性、准确性、阳性似然比、阴性似然比。结果经CECT证实17例AP发生SVCs，其中CDFI诊断4例，CEUS诊断12例。CDFI的AUC为0.618；CEUS的AUC为0.853。CDFI的敏感性、特异性、准确性、阳性似然比、阴性似然比分别是：17.65%，99.21%，89.58%，22.34，0.83；CEUS的上述参数值为58.82%，98.43%，93.75%，37.46，0.42。CEUS对于SVCs的诊断效能高于CDFI（Z=2.233, P<0.05）。结论 CEUS相较于CDFI，对SVCs诊断更加有效、准确。

Abstract: Objective To evaluate the diagnostic value of color Doppler flow imaging (CDFI) and contrast enhanced ultrasonography (CEUS) for splenic vein complications （SVCs）.Methods 144 inpatients (86 male, 58 female) with acute pancreatitis from Jan 2012 to Apr 2013 were recruited for this study. The participants had a mean age of (44.3±11.9) years. All participants were examined using CDFI, CEUS and contrast enhanced computer tomography (CECT) (less than 72 h interval between examinations).The CECT results were regarded as a golden standard, which were compared with the results of CDFI and CEU. The Medcalc 12.7.1.0 was used for drawing ROC curves and calculating AUC. Results The CECT confirmed 17 cases of SVCs; whereas, the CEUS identified 12 cases and the CDFI identified 4 cases of SVCs. The difference between the results of CDFI and CEUS was significant (Z=2.233,P＜0.05).Higher levels of sensitivity (58.82%), specificity (98.43%),accuracy (93.75%), positive likelihood ratio (37.46),and negative likelihood ratio (0.42) were found using CEUS for diagnosing SVCs, compared with those of using CDFI (sensitivity=17.65%, specificity=99.21%,accuracy=89.58%, positive likelihood ratio=22.34,negative likelihood ratio=0.83). The area of AUC were 0.618 and 0.853 for CDFI and CEUS, respectively. Conclusion CEUS is a better imaging method for diagnosing SVCs in patients with acute pancreatitis.

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