多模态MRI、CT多期增强扫描联合D-二聚体对重症急性胰腺炎的预后评价作用分析

摘要 目的：分析多模态MRI、CT增强扫描联合D-二聚体对重症急性胰腺炎（SAP）的预后评价作用。方法：收集2018年7月至2021年12月于我院诊治的85例SAP患者的影像学及临床资料。所有患者入院48小时内均接受多模态MRI及CT多期增强扫描检查，入院24小时内完善D-二聚体测定，分析多模态MRI、CT多期增强扫描、D-二聚体单独及联合应用对SAP患者预后的评价效能。结果：（1）经MRSI评分，低分组52例，高分组33例，低分组住院天数、病死率低于高分组（P<0.05）；（2）经MCTSI评分，低分组42例，高分组43例，低分组住院天数、病死率低于高分组（P<0.05）；（3）以2 mg/L为界，D-二聚体低水平组39例，高水平组46例，低水平组住院天数、病死率低于高水平组（P<0.05）；（4）MRSI评分、MCTSI评分、D-二聚体水平预测SAP预后的ROC曲线下面积（AUC）分别为：0.804、0.738、0.810，三种方式均能有效预测SAP的死亡，且D-二聚体水平> MRSI评分>MCTSI评分；（5）多模态MRI、CT多期增强扫描联合D-二聚体诊断SAP的灵敏度为94.77%，特异度为92.58%，均高于多模态MRI、CT多期增强扫描、D-二聚体三种方法单独诊断以及两两结合诊断（P<0.05）。结论：多模态MRI、CT多期增强扫描联合D-二聚体共同检查可提高SAP诊断的灵敏度及特异度，有助于提高对患者预后评估的准确率。

Analysis of Prognostic Evaluation Function of Multi-modal MRI and Multi-phase Enhanced CT Combined with D-dimer in Severe Acute Pancreatitis

ABSTRACT Objective: To analyse the prognostic evaluation function of multi-modal MRI and multi-phase enhanced CT combined with D-dimer in severe acute pancreatitis (SAP). Methods: The imaging and clinical data of 85 patients with SAP diagnosed and treated in our hospital from July 2018 to December 2021 were collected. All patients received multi-phase enhanced CT and multi-modal MRI within 48 hours after admission. D-dimer was measured within 24 hours after admission. The evaluation efficiency of multi-modality MRI, multi-phasic enhanced CT, D-dimer alone and in combination in prognosis of SAP patients were analyzed. Results: (1) According to the MRSI score, 52 cases were in low score group and 33 cases were in high score group, and the length of hospital stay and the mortality rate in low score group were lower than those in high score group (P<0.05); (2) According to the MCTSI score, 42 cases were in low score group and 43 cases were in high score group, and the length of hospital stay and the mortality rate in low score group were lower than those in high score group (P<0.05); (3) Taking 2 mg/L as the boundary, there were 39 cases in the low-level group and 46 cases in the high-level group, and the hospital stay and mortality rate were lower in low-level group were lower than those in high-level group (P<0.05); (4) The area under ROC curve (AUC) of MRSI score, MCTSI score and D-dimer level in predicting the prognosis of SAP were 0.804, 0.738 and 0.810, all three methods can effectively predict the death of SAP, and D-dimer level > MRSI score > MCTSI score. (5) The sensitivity and specificity of multi-modal MRI and multi-phase enhanced CT combined with D-dimer in the diagnosis of SAP were 94.77% and 92.58%, which were higher than those of multi-modal MRI, multi-phase enhanced CT, D-dime alone and pairwise combination (P<0.05). Conclusion: Multi-modality MRI and multi-phase enhanced CT combined with D-dimer examination can improve the sensitivity and specificity of the diagnosis of SAP, and help to improve the accuracy of prognostic assessment.