급성 췌장염에서 CT 예후인자의 유용성

Abstract

Background/Aims: To evaluate the value of CT prognostic factors in acute pancreatitis. Methods: In 48 patients with acute pancreatitis, clinical course and CT findings were analyzed retrospectively. Clinical severitv was classified as severe and mild form, based on the definition of Atlanta symposiurn. CT grades were classified as A, B, C, D, E and pancreatic necrosis as 0, 30",o, 50% & more than 50%. CT severity index(CTSI) was acquired by the sum of the points of CT grade(0, 1, 2, 3, 4 for each grade) and pancreatic necrosis(0, 2, 4, 6 for each degree of necrosis). Results: Among 48 patients, thirteen patients(29%) showed severe clinical course and the remaining(717o) showed a mild course. Patients with CT grade D & E were 63% among all patients,and 40% of these patients had severe form. Among 13 with severe form, acute fluid collection was observed in 92% patients. The common sites of acute fluid collection were anterior pararenal space and lesser sac. Pancreatic necrosis was observed in 29% of patients and 85% of these patients had severe form. CT grades of patients with pancreatic necrosis were D or E. The average CTSI for all patients was 3.5 and there was significant difference(p<0.01) between mild(2.5) and severe form(6.2). The sensitivity and specificity for severe form, when CTSI was greater than 4, were 85% and 94%. Conclusions: CT prognostic factors, including CT grade, pancreatic necrosis and CTSI, were useful for predicting the clinical course of patients with acute pancreatitis. (Korean J Gastroenterol 1997;29: 362-369)