The Correlatiions Between The Commonly Computed Tomography Features Of Extrapancreatic And The Severity Of Disease In Early Acute Pancreatitis

Object:By investigating the correlations between the commonly spiral computed tomography features of extrapancreatic and the severity of disease in early acute pancreatitis(AP),we explore features of high diagnostic value for the severity of acute pancreatitis,in order to provide information to assess the severity of acute pancreatitis early and give patients timely and effective treatment.Methods:Clinical data of patients,who were diagnosed acute pancreatitis in southwest medical university from 2014 December to2017 December,were analyzed retrospectively.According to the inclusion and exclusion criteria,the data of 190 patients with chest and abdomen CT scan within 48 hours were collected.Assessed the severity of the disease according to the revised Atlanta classification criteria.Acute pancreatitis was divided into mild acute pancreatitis,moderately severeacutepancreatitisandsevereacutepancreatitis sub-groups.Observed and recorded the changes of commonly CT signs of chest,liver,gall bladder,spleen,gastric bare area,gastrointestinal,left subphrenic fat,adrenal,retroperitoneal space,omental bursa,abdominal wall and ascites,the number of peripancreatic fluid collection regions in all cases.Analysised the CT features which related with severity of disease and compared the size of the correlations.Results:This study included 190 patients with acute pancreatitis,examinations of plain CT scan in 169 patients of them,and 21 patients of them underwented contrast enhanced CT scan.1.When disease aggravated,acute pancreatits with pleural effusion,atelectasis increased with it(P<0.001);The number of patients of AP with pulmonary exudate were 44(23.2%),with pulmonary consolidation were 5(2.6%),and there was no case of pulmonary edema.Pulmonary exudate(X~2=0.755,P=0.686),pulmonary consolidation(P=0.478)were not related to the severity of the disease.2.The prevalence of CT value of liver/spleen<1 increased gradually as disease worsens,the difference between groups were statistically significant(X~2=6.916,P=0.009).CT value of liver was not related to the severity of the disease.Left adrenal(r=0.234,P=0.001)and right adrenal(r=0.173,P=0.017)involvement were positively correlated with clinical severity of acute pancreatitis.Spleen involvement was not related to the severity of the disease.3.The trends of the prevalence of gall bladder involvement(X~2=22.550,P<0.001),stomach involvement(X~2=26.294,P<0.001),bowel involvement(X~2=17.075,P<0.001),and gastrointestinal involvement(X~2=21.813,P<0.001)increased as disease worsens,they were related with the severity of acute pancreatitis.4.The portion of acute pancreatitis involving gastric bare area(X~2=14.503,P<0.001),left subphrenic fat(X~2=14.846,P<0.001),omental bursa(X~2=31.864,P<0.001),mesentery(X~2=24.910,P<0.001),ascites(X~2=37.164,P<0.001),abdominal wall(X~2=13.540,P<0.001)increased as disease worsens,they were related with the severity of acute pancreatitis.CT grading of retroperitoneal space involvement(r=0.377,P<0.001),the number of peripancreatic fluid collection regions(r=0.392,P<0.001)were positively correlated with the severity of acute pancreatitis.5.The positive results of multivariate analysis showed that the regression coefficient of pleural effusion,CT value of liver/spleen<1and gall bladder,omental bursa,mesentery involvement were 2.340?1.934?2.992?3.121?2.006(P<0.05)respectively.They were independent risk factors which cause serious illness.Conlusion:1.Pleural effusion,CT value of liver/spleen<1 and gall bladder,omental bursa,mesentery involvement are independent risk factors which cause serious illness,they are more valuable to assess the severity of AP earlier.The correlation between them and the severity of AP from large to small in turn are omental bursa involvement,gall bladder involvement,pleural effusion,mesentery involvement,CT value of liver/spleen<1.2.Atelectasis,gastric bare area involvement,the number of peripancreatic fluid collection regions,left subphrenic fat involvement,adrenal involvement,CT grading of retroperitoneal space involvement,stomach involvement,bowel involvement,gastrointestinal involvement,ascites and abdominal wall involvement are related with severity of acute pancreatitis.3.pulmonary exudate,pulmonary consolidation,CT value of liver,spleen involvement are not related to the severity of AP.