CT与MRI诊断胰腺癌方案优选的多中心研究  

Comparison of MSCT and MR for the diagnosis of pancreatic cancer:a multicenter study

作　　者：马霄虹[1] 赵心明[1] 张红梅[1] 欧阳汉[1] 曾蒙苏 宋彬[3] 郭宁[1] 胡敏霞[1] 张瑾[1] 叶枫[1] 胡毅[1] 屈东[1] 周纯武[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院影像诊断科,100021 [2]上海复旦大学附属中山医院放射科 [3]四川大学华西医院放射科

出　　处：《中华临床医师杂志（电子版）》2011年第21期6260-6265,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金："十一.五"国家科技及支撑课题(2007BAI05B05);北京希望马拉松专项基金(LC2009B31)

摘　　要：目的探讨CT平扫和增强及MR平扫和增强分别对胰腺癌的诊断价值,并对影像诊断方法进行优选。方法收集144例经手术或穿刺病理证实的胰腺疾病,分别以CT平扫、CT增强、CT综合(CT平扫+增强)、MR平扫、MR增强、MR综合(MR平扫+增强)进行定性诊断,以病理为金标准,使用ROC曲线分析,比较各方法的诊断价值。结果 (1)CT及MR扫描方法内和方法之间的诊断价值比较:CT平扫的诊断准确性低于CT增强和CT综合,MR平扫的诊断准确性低于MR增强和MR综合,且差异具有统计学意义;CT增强与CT综合及MR增强与MR综合的诊断准确性差异无统计学意义。(2)方法之间的诊断价值比较:CT平扫的诊断准确性低于MR增强和MR综合,且差异具有统计学意义;余各扫描方法之间两两比较,诊断准确性差异无统计学意义。(3)取约登指数最大值对应的诊断点为诊断界值时,诊断胰腺癌的敏感性:CT平扫<MR平扫<MR增强<MR综合<CT增强<CT综合;特异性:CT平扫为89.47%,CT增强、CT综合、MR平扫、MR增强、MR综合均为94.74%。结论 (1)对胰腺癌的诊断可不行CT或MR平扫,但必须进行CT或MR增强扫描;(2)临床诊断胰腺癌只需选择CT增强或MR增强扫描两者之一即可。Objective To compare the results of multislice CT(MSCT) and high-field MR in the diagnostic evaluation of pancreatic cancer(PC),and to evaluate the superiority of the two imaging modalities.Methods 144 patients with pathology verified pancreatic diseases underwent CT and MRI,including plain CT scan(p-CT),enhanced CT scan(e-CT),plain MRI(p-MRI)and enhanced MRI(e-MRI).All the results of the imaging methods(including p-CT,e-CT,plain plus enhanced CT scan(ppe-CT),p-MRI,e-MRI and plain plus enhanced MRI(ppe-MRI)were compared with pathology findings to calculate the ROC curve area and to compare the accuracy,sensitivity,specificity,positive and negative predictive value(PPV and NPV)for PC identification of the two methods,respectively.Results The accuracy of p-CT was significantly lower than e-CT,ppe-CT,e-MRI and ppe-MRI,respectively.The accuracy of p-MRI was significantly lower than e-MRI and ppe-MRI,respectively.There was no significant difference among the other imaging methods in the diagnostic accuracy.To the PC identification,sensitivity:p-CT<p-MRI<e-MRI<ppe-MRI<e-CT<ppe-CT,specificity:all except p-CT(89.47%)were the same(94.74%).Conclusions The p-CT or p-MRI alone is not efficient enough to the identification of PC,the e-CT or e-MRI should be considered as the necessary scanning methods.Comparing with e-CT and e-MRI has an equivalent diagnostic value in the evaluation of patients with PC.

关 键 词：胰腺肿瘤 体层摄影术 螺旋计算机 磁共振成像 

分 类 号：R735.9[医药卫生—肿瘤]