MR动态增强鉴别诊断胰腺癌与肿块型胰腺炎  

Dynamic contrast-enhanced MRI in differentiation of pancreatic carcinoma from mass-forming focal pancreatitis

作　　者：张霆霆[1] 王莉[1] 陆建平[1] 柏梅[1] 

机构地区：[1]第二军医大学附属长海医院医学影像科,上海200433

出　　处：《中国医学影像技术》2010年第9期1721-1724,共4页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨MR动态增强对胰腺癌(PC)与肿块型胰腺炎(FP)的诊断与鉴别诊断价值。方法收集经手术病理或临床证实的PC患者28例、FP患者15例及正常胰腺对照20名。各受检者均接受胰腺MR五期动态增强扫描。采用感兴趣区(ROI)法测量胰腺肿块及其周边胰腺各期信号值,计算胰腺肿块各期强化率,并绘制出肿块区及周边胰腺时间-信号强度曲线(TIC)。根据强化峰值时间将TIC分为五型(依次为注射对比剂后18s、45s、75s、150s、240s达到峰值),即Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型。根据TIC尾部走行趋势,将肿块区的每型进一步分为两个亚型,即a(缓慢下降)型与b(平台趋势)型。结果正常胰腺动态增强均呈Ⅰ型强化曲线。Ⅳb及Ⅴ型仅出现在PC中(P=0.036、0.008),Ⅰa及Ⅱa仅出现在FP中(P=0.037、<0.001),肿块周边胰腺的Ⅰ型强化曲线更多见于PC(P=0.027),且动脉期PC的强化率低于FP的强化率(P=0.031)。结论 MR多期动态增强扫描有助于诊断、鉴别诊断PC与FP。Objective To observe the value of multi-phase dynamic contrast enhancement MRI （DCE-MRI） in diagnosis and differential diagnosis of pancreatic carcinoma （PC） and mass-forming focal pancreatitis （FP）. Methods All the subjects underwent five phases DCE-MRI were divided into 3 groups, i.e. pancreatic carcinoma （n=28） confirmed by pathology, mass-forming focal pancreatitis （n=15） confirmed by pathology or clinical diagnosis, and normal pancreas （n=20）. Signal intensity of ROI was measured at the pancreas on all five phases, and for each, the enhanced rate was calculated. Meanwhile, time-signal intensity curves （TIC） of the mass and the remaining pancreas were obtained in all the groups. Then the patterns of the TICs were classified into 5 types according to the time of a peak （18 s, 45 s, 75 s, 150 s, 240 s after bolus injection of contrast material）, namely, type-Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, respectively. Then according to the profile of the tail of TIC, the type of the masses were classified into two subtypes, subtype-a （slow decline） and subtype-b （plateau）. Results All normal pancreases had demonstrated TIC type-Ⅰ. Type-Ⅳb and type-Ⅴ TIC were only recognized in PC （P=0.036, 0.008）, while type-Ⅰa and type-Ⅱa only in FP （P=0.037, 0.001）. Furthermore, type-Ⅰ TIC in the remaining pancreas was recognized more in PC than FP （P=0.027）. Besides, in the arterial phase, enhanced rate in PC was lower than in FP （P=0.031）. Conclusion Multi-phases DCE-MRI may help to differentiate PC from mass-forming FP.

关 键 词：磁共振成像 诊断显像 胰腺肿瘤 胰腺炎 

分 类 号：R735.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]