| Purpose:To probe into the spiral CT features and their incidence of the left adrenal gland involvement in acute pancreatitisMaterials and Methods:1. Research subjects: Consecutive patients of acute pancreatitis (AP) identified clinically and/or pathologically from Jan. 2001 to Dec. 2002 in West China Hospital were included in our study. All of these AP patients underwent CT scan. Those patients with severe liver cirrhosis and hypoproteinia (blood serum protein less than 30g/L), and presented with abdominal operation and inflammative, hemorrhagic and malignant diseases in abdomen were all excluded from this study. And those patients whose CT images were not fit for the analysis were excluded too. This study consisted of 138 patients with AP, of which there were 97 male, 41 female, and their age ranged from 18-88 years, the mean age 49.3 years.2. CT scanner and scanning parameters: In our study, a Siemens plus 4 version A CT scanner and Medrad-100 power injector were used. Contrast materials were Ultravist (300mg/ml, Schering Germany) orOmnipaque (300mg/ml, Nycomed, Norway )0 All of these patients in this study underwent spiral CT scan with a scanning coverage from the dome of the diaphragm to the pelvic floor with two-breath-holds. Of 138 patients, 121 patients including two phase study 9 cases, received I.V. contrast materials injection and the remaining 17 patients underwent plain scan. Parameters of CT scans were: 120kv, 240mA, 5mm-10mm collimation, 5mm-10mm table feed speed per second, pitch =1 and 6mm to 8mm reconstruction slice width.3. Image Interpretation: Three experienced radiologists specified with the abdominal radiology retrospectively analyzed all the images obtained in consensus with blind to the clinical information. Emphasis was placed on the imaging interpretation concerning the spiral CT features of the left adrenal gland involvement, the incidence and the grade of the left adrenal gland involvement according to the grading criteria, and finally the dynamic changes of the left adrenal gland in the follow-up CT scans. The definition and criteria of the grading of the left adrenal gland involvement in AP was as follows: Grade 1, no abnormality with the left adrenal gland; Grade 2, hazy and streaky shadows adhere to the left adrenal gland and the area of the gland involved less than 1/2; Grade 3, the left adrenal gland fully involved anteriorly; Grade 4, On the basis of grade 3, plus swelling, deformity and hypoattenuation of left adrenal gland, or enclosed by the fluid collection or phlegmon.4. Clinical Severity classification of AP: Two clinical classification systems were employed ir this study. 1) Ranson classification criteria and 2) Atlanta classification criteria.Results:1. According to the criteria of left adrenal gland involvement, there were 3 types of involvement presented in our study. The total incidence of left adrenal involvement was 71%, and Grade 1 to Grade 4 were 29%, 42.8%, 15.9% and 12.3% respectively.2. Clinical severity classification: according to the Atlanta Criteria 92, type 1 to type 3 of AP were 26.8%(37/138), 34.1%(47/138), and 39.1%(54/138) respectively; and according to the Ranson Criteria, type 1 to 3 of AP which 125 patients could be included in this classification were 44.8%(56/125), 44.8%(56/125) and 10.4%(13/125).3. The follow-up changes of the left adrenal gland involvement were paralleled with peripancreatic involvement and the combined consequence of medical management and natural course of acute pancreatitis.Conclusion:1. The involvement of left adrenal gland is one of the CT features in AP, of which the incidence is 71%.2. The CT features of left adrenal involvement may present as three types: involvement from part of the left adrenal gland to whole gland, even swelling and deformity and hypoattenuation of the gland.3. The dynamical changes of the left adrenal gland involvement correlate with the consequence of medical management and natural course of AP. |
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