CT增强扫描及磁共振DWI序列对肿块型胰腺炎与胰腺癌的鉴别诊断价值  

CT enhancement scanning and diffusion-weighted magnetic resonance imaging for differential diagnosis between chronic mass-forming pancreatitis and pancreatic carcinoma

作　　者：吕琦[1] 王培军[1] 邵志红[1] 倪炯[1] 王国良[1] 

机构地区：[1]同济大学附属同济医院影像科,上海200065

出　　处：《第二军医大学学报》2013年第9期974-979,共6页Academic Journal of Second Military Medical University

摘　　要：目的探讨CT增强扫描及磁共振水分子扩散加权成像(diffusion-weighted imaging,DWI)对胰腺癌与肿块型胰腺炎的鉴别诊断价值。方法回顾性分析2008年1月至2012年10月我院101例肿块型胰腺病变患者的临床资料,将腹部增强CT诊断与病理结果进行对照,计算增强CT诊断肿块型胰腺病变的敏感性、特异性、准确率、阳性预测值、阴性预测值。比较肿块型胰腺炎与胰腺癌的CT表现差异,分析病灶的大小、部位、形态(强化情况、钙化、假囊肿形成、胰胆管扩张)、肾周筋膜增厚、对胰周大血管的侵犯、是否合并转移等指标,明确鉴别诊断要点。总结所有患者胰腺磁共振DWI序列(b值800s/mm2)图像特点,测量每组表观弥散系数(ADC)值,并与正常胰腺组织进行对比分析。结果 101例患者中,病理诊断胰腺癌59例,肿块型胰腺炎42例,CT诊断的敏感性94.9%,特异性88.1%,准确率92.1%,阳性预测值91.8%,阴性预测值92.5%。增强前后的CT值、胰腺及胰管钙化、假囊肿、胰胆管扩张、胰周血管的侵犯及是否合并转移对肿块型胰腺炎与胰腺癌的鉴别有价值(P<0.05)。胰腺癌与肿块型胰腺炎的ADC值差异无统计学意义,两者与正常胰腺相比差异有统计学意义(P<0.01)。结论 CT增强扫描有利于鉴别诊断肿块型胰腺炎与胰腺癌,MRI DWI序列对肿块型胰腺炎及胰腺癌鉴别诊断可能价值有限。Objective To explore the values of CT enhancement scanning and diffusion-weighted magnetic resonance imaging （DWI） in differential diagnosis between chronic mass-forming pancreatitis and pancreatic carcinoma. Methods The clinical data of 101 patients with pancreatic lesions （Jan. 2008 to Oct. 2012） were retrospectively analyzed. The results of abdominal CT enhancement scanning were compared with the postoperative pathological findings, and the sensitivity, specificity, accurate rate, positive predictive value, and negative predictive value of CT enhancement scanning were calculated. The CT findings of mass forming pancreatitis and pancreatic carcinoma were compared. The size, site, shape （reinforcement levels after enhancement, calcification, pseudoeyst, and dilated pancreatic duct） of the lesions, the perirenal fascia thickening, peripancreatic vessel invasion, and metastasis status were analyzed and the key diagnostic points were identified. Pancreatic DWI imaging characteristics of all the patients using b value 800 s/mm2 was analyzed and the apparent diffusion coefficient （ADC） values of the two groups were compared with normal pancreatic tissues. Results Of the 101 pancreatic lesions, 59 were pathologically diagnosed as pancreatic cancer and 42 as mass-forming pancreatitis. The sensitivity, specificity, accurate, positive predictive value, and negative predictive value of CT findings were 94.9%, 88.1%, 92.1%, 91.8%, and 92.5%, respectively. CT values before and after enhancement, calcification of pancreas and pancreatic duct, pseudocyst, dilated pancreatic duct and bile capillary, peripancreatic vessel invasion, and metastasis were of significant values for differential diagnosis between chronic mass forming pancreatitis and pancreatic carcinoma（P〈0. 05）. No significant difference in ADC values was found between chronic mass-forming panereatitis and pancreatic carcinoma, but ADC values of chronic mass forming pancreatitis and pancreatic carcinoma were significantly different from that o

关 键 词：胰腺肿瘤 慢性胰腺炎 X线计算机体层摄影术 磁共振水分子扩散加权成像 

分 类 号：R735.9[医药卫生—肿瘤] R576.2[医药卫生—临床医学]