Multiple MRI score systems versus Acute Physiology,Age and Chronic Healthy Evaluation Ⅱ score in predicting the severity of acute pancreatitis:a ROC analysis

摘要

Objective:The purpose of this study was to compare the accuracy of multiple magnetic resonance imaging (MRI)scoring systems and Acute Physiology,Age,and Chronic Health Evaluation (APACHE)Ⅱ score for predicting the severity of acute pancreatitis (AP).Methods:This retrospective study was approved by our institutional review board.Pa-tient informed consent was waived.161 patients with AP undergoing abdominal contrast-enchanced MRI (CEMRI)(n=75) and nonenchanced MRI (n=86)were included in this study.Balthazar grade,MR severity index (MRSI),modified MRSI (MMRSI),extrapancreatic inflammation on MR (EPIMR)score,mesenteric oedema and peritoneal fluid score (MOP)were graded in 75 patients with CEMRI,three of above mentioned five MRI scoring systems(MRSI and MMRSI were excluded) were graded in all 161 patients.MRI score systems and APACHE Ⅱ were comparatively evaluated for predicting clinically severe AP and mortality with receiver operating curve analysis.Results:In all the 161 patients,.25 patients (15.5%)were diagnosed as clinically severe AP,and 6 patients died (3.7%).MRSI indicated the higher accuracy for predicting clinically severe AP and mortality in 75 patients with CEMRI,EPIMR score indicated the higher accuracy for predicting clinically se-vere AP and mortality in all 161 patients.However,There were no statistically significant differences between the predictive accuracies of MRI scoring systems and APACHE Ⅱ score (P >0.05).Conclusion:MRI scoring systems were not superior to the APACHE Ⅱ score in predicting severity of AP,a MRI on admission solely for severity assessment in AP is not rec-ommended.%目的：评价多种磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度的准确性。方法：临床确诊161例急性胰腺炎患者接受 MRI 检查（其中平扫86例，平扫＋增强75例），对75例急性胰腺炎 MRI 增强患者，五种磁共振评分系统（Balthazar 分级、磁共振严重指数、修正磁共振严重指数、胰外炎症磁共振评分、肠系膜水肿与腹膜腔积液评分）对其严重程度进行评价，对所有161例急性胰腺炎患者，三种磁共振评分系统（Balthazar 分级、胰外炎症磁共振评分、肠系膜水肿与腹膜腔积液评分）对其严重程度进行评价。利用 ROC 曲线比较分析磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度的准确性。结果：161例急性胰腺炎患者，25例（15．5％）临床上确诊为重度急性胰腺炎，6例（3．7％）死亡。磁共振严重指数、胰外炎症磁共振评分预测急性胰腺炎严重程度及死亡具有较高的准确性，但磁共振评分系统与急性生理年龄慢性健康评分系统Ⅱ预测急性胰腺炎严重程度无显著差异（P ＞0．05）。结论：与急性生理、年龄、慢性健康评分系统Ⅱ比较，磁共振评分系统预测急性胰腺炎严重程度没有优势，急性胰腺炎入院接受 MRI 检查评价严重程度不被推荐。