3.0T磁共振自由呼吸背景抑制弥散加权成像对胰腺肿块的诊断价值  

Value of Free-Breathing Diffusion-Weighted MR Imaging with Background Suppression by Inversion Recovery at 3.0T for the Diagnosis of Solid Pancreatic Masses

作　　者：姚秀忠[1] 刘豪[1] 陈文芳[1] 曾蒙苏[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032

出　　处：《中国临床医学》2013年第1期64-66,共3页Chinese Journal of Clinical Medicine

基　　金：上海市自然科学基金(编号:12ZR1429600);上海市级医院新兴前沿技术项目(编号:SHDC12010120)

摘　　要：目的:评价3.0T磁共振自由呼吸背景抑制弥散加权成像在胰腺肿块性病变中的鉴别诊断价值。方法:采用3.0T磁共振对58例胰腺肿块患者(胰腺癌患者30例、肿块型胰腺炎患者9例、实性假乳头状瘤患者9例及神经内分泌肿瘤患者10例)以及15例健康志愿者(对照组)行常规T1WI、频率饱和脂肪抑制T2WI、MRCP、DWI及三维LAVA平扫,并对所有患者进行增强扫描,自由呼吸背景抑制DWI基于SE-EPI序列及b值分别为0s/mm2和600s/mm2。比较不同组织的表观弥散系数(apparent diffusion coefficient,ADC)值,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析其诊断效能。结果:组织的ADC值由高到低依次为正常胰腺、神经内分泌肿瘤、胰腺癌、肿块型胰腺炎和实性假乳头状瘤。单因素方差分析显示,不同组织的ADC值的差异有统计学意义(F=22.573,P<0.001);LSD两两检验显示,肿块型胰腺炎、胰腺癌及正常胰腺的ADC值之间差异有统计学意义(P均<0.001)。以ADC≥0.00133mm2/s为标准,从肿块型胰腺炎中鉴别诊断胰腺癌,灵敏度和特异度分别为86.7%和88.9%,阳性预测值96.3%,阴性预测值66.7%;以ADC≤0.00125mm2/s为标准,从神经内分泌肿瘤中鉴别实性假乳头状瘤,灵敏度和特异度分别为77.8%和100%,阳性预测值100%,阴性预测值83.3%。结论:行3.0T磁共振,自由呼吸背景抑制DWI序列的ADC值能够较好地反映正常胰腺及胰腺肿块的组织病理生理特征,有助于胰腺肿块的诊断与鉴别诊断。Objective：To assess the value of free-breathing diffusion-weighted MR imaging with background suppression by inversion recovery at 3.0T for the differential diagnosis of solid pancreatic masses.Methods：A total of 58 patients with solid pancreatic masses have been enrolled,including 30 cases of pancreatic cancer,9 cases of mass-like pancreatitis,9 cases of solid pseudopapillary tumor of pancreas（SPTP） and 10 cases of pancreatic neuroendocrine tumor（PET）.Fifteen healthy volunteers have also been enrolled as control group.All of them underwent T1WI,T2WI,MRCP,DWI,non-enhanced LAVA and enhanced LAVA.Free-breathing diffusion-weighted MR imaging with background suppression by inversion recovery was done.SE-EPI sequence and b values were 0 and 600.Apparent diffusion coefficient values（ADC） in tissues from different groups have been compared,and receiver operating characteristic（ROC） curves were used to analyze the efficiency.Results： ADC value was the highest in the control group,which was followed by PET,pancreatic cancer,mass-like pancreatitis and SPTP.Significant differences in ADC values were found among different groups by analysis of variance（ANOVA）（P0.001）.LSD test showed that there were significant differences in ADC values among pancreatic cancer,mass-like pancreatitis and normal pancreas（P0.001）.Sensitivity,specificity,positive predictive value and negative predictive value were 86.7%,88.9%,96.3% and 66.7%,respectively,when ADC≥ 0.00133 mm2/s was used as cutoff value for differential diagnosis of pancreatic cancer from mass-like pancreatitis.They were 77.8%,100%,100% and 83.3%,respectively,when ADC≤ 0.00125 mm2/s was used as cutoff value for differential diagnosis of SPTP from PET.Conclusions： ADC values in free-breathing diffusion-weighted MR imaging with background suppression by inversion recovery at 3.0T can reflect histopathological patterns of normal pancreas and pancreatic lesions,which is useful in the differential diagnosis of pancreatic masses.

关 键 词：肿瘤 胰腺 磁共振成像 表观弥散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学]