MR多参数成像评估慢性胰腺炎临床分级的价值  

Evaluation of MR multiparameter imaging for clinical classification of chronic pancreatitis

作　　者：柏梅[1] 陆建平[1] 赖晓伟[2] 

机构地区：[1]第二军医大学长海医院放射科,上海200433 [2]第二军医大学长海医院消化内科

出　　处：《中华胰腺病杂志》2010年第5期305-308,共4页Chinese Journal of Pancreatology

基　　金：国家自然科学基金（2006BA102A12）

摘　　要：目的探讨应用多种MRI技术评估慢性胰腺炎（CP）临床分级的价值。方法纳入经病理和临床随访证实的65例CP患者，按M—annheim分级分为轻度组（14例）、中度组（37例）和进展组（14例），并以20例健康志愿者作为对照。在上腹部常规T1WI及T2WI抑脂扫描后，进行胰腺MRCP检查及胰腺动态MR检查。测量T1WI、T2WI加权扫描的胰腺实质信号及肝脏信号，获取它们的比值（rT1、rT2），根据MRCP测量主胰管最大直径（MPD），并对胰腺病变进行评估、分类；测量动态MR增强时胰腺实质信号值，并计算强化率；ROC分析MRI表现与CP临床分级的相关性。结果正常、轻度、中度和进展组rT1分别为0．98±0．27、0．84±0．12、0．81±0．16和0．75±0．24，中度、进展组较正常组明显降低（P〈0．01）；rT2分别为1．28±0．30、1．46±0．44、1．46±0．55和1．76±0．72，各组间无统计学差异；MPD为（2．0±0．6）mm、（5．4±2．4）mm、（6．5±3．3）mm和（8．1±4．1）mm，各组间差异显著（P值均〈0．01）。轻度、中度和进展组的剑桥重度分级分别有4例（29％）、33例（90％）和13例（93％），差异显著（P〈0．01）；胰管结石分别有2例（14％）、11例（30％）和5例（36％），胰腺假性囊肿分别有0例、6例（16％）和3例（21％），胰腺萎缩分别有4例（29％）、22例（60％）和10例（71％），各组间均无统计学差异。正常、轻度、中度和进展组的胰腺动态增强扫描实质期与动脉期胰腺信号强化率比值（P／A）分别为0．88±0．08、1．10±0．08、1．37±0．15和1．48±0．53，各组间差异显著（P〈0．05）。rT1值、剑桥分级、胰管直径及P／A比值与临床分级均有相关性（r值分别为0．34、0．41、0．62、-0．43）。ROC分析显示，MPD〉2．5mm、rT1〈0．8、P／A〉0．8诊断CP均有较好的敏感性和特异性，三者结合时诊断CP的特异�Objective To investigate the value of MR multiparameter imaging for the clinical classification of chronic pancreatitis. Methods 65 patients with confirmed chronic pancreatitis by follow-up and pathologic examinations （14 mild, 37 moderate and 14 severe according to MANNHEIM system） and 20 healthy volunteers were included in this study. MR examination including routine T1WI, T2WI, MRCP and dynamic enhanced MRI. The data were measured and statistical analysis was applied in four groups. Two radiologists assessed pancreatic duct diameter, pancreatic size, pancreatic cyst, pancreatic stone and pancreatic signal intensity on MRCP, T1-weighted and T2-weighted images. Pancreatic signal intensity were also measured on dynamic enhanced MR. Results Mean values of pancreatic signal intensity ratio on T1WI （rT1） in the pancreas were significantly reduced in patients with moderate and severe CP compared with volunteers.There was significant difference among four groups （normal, 0.98 ± 0.27; mild, 0.84 ± 0. 12; moderate, 0.81 ±0.16; severe, 0.75 ±0.24）. Mean values of pancreatic signal intensity ratio on T2WI （rT2） in the pancreas were no difference among four groups （ normal, 1.28 ± 0. 3 ; mild, 1.46 ± 0.44, moderate, 1.46 ±0.55; severe, 1.76 ±0.72）. Pancreatic duct diameters were significantly increased in mild, moderate and severe CP groups [ mild （ 5.3 ± 2.4） mm; moderate （ 6.5 ± 3.3 ） mm ; severe （ 8.1 ± 4.1 ） mm ] compared with patients without CP [ （2.0 ± 0. 6） mm; 19 〈 0. 01 ]. Severe degree of Cambridge classification was graded as mild in 4 （29%） , moderate in 33 （89%） , severe in 13 （93%）. Pancreatic calcification was graded as mild in 2 （ 14% ） , moderate in 11 （30%） , severe in 5 （36%）. Pancreatic pseudoeyst was graded as mild in 0, moderate in 6 （16%）, severe in 3 （21.43%）. Pancreatic parenehymal atrophy was graded as mild in 4 （29%） , moderate in 22 （59%） , severe in 10 （71%）. They did not vary among CP groups. Parench

关 键 词：胰腺炎 慢性 磁共振成像 动态增强 

分 类 号：R445.2[医药卫生—影像医学与核医学]