磁共振成像在自身免疫性胰腺炎诊断与鉴别诊断中的价值  

Diagnosis and differential diagnosis value of magnetic resonance imaging in autoimmune pancreatitis

作　　者：汪建华[1] 王玉涛[1] 马小龙[2] 张建 孙高峰 左长京 

机构地区：[1]宁波大学医学院附属医院影像科,315020 [2]上海长海医院放射科 [3]核医学科

出　　处：《中华消化杂志》2014年第4期260-265,共6页Chinese Journal of Digestion

基　　金：上海市国际科技合作基金（10410708800）;中国博士后科学基金（20100480545）;浙江省自然基金（LYl3H070008）;浙江省医药卫生科技计划（2013KYAl82、2012KYBl76）;宁波市自然科学基金（2013A610256、2010A610062）

摘　　要：目的探讨MRI多序列联合应用在自身免疫性胰腺炎（AIP）诊断和鉴别诊断中的价值。方法回顾性分析12例AIP患者的MRI资料，包括T1加权成像、T2加权成像、磁共振胰胆管成像（MRCP）、弥散加权成像（DWI）和动态增强扫描。观察病变累及部位、范围、信号及动态强化方式，胰胆管的改变、假包膜征及其他伴随征象。将正常胰腺及胰腺癌患者各12例作为对照。AIP组与胰腺癌组影像学征象比较采用Fisher确切概率法。在DWI序列上测量3组胰腺感兴趣区表观弥散系数（ADC）值，采用LSD-t检验比较。在增强MRI各期测量3组胰腺感兴趣区与同层面左侧竖脊肌信号强度比值，采用Pillai＇s Trace检验比较。结果12例AIP患者中，7例为弥漫性，4例为局灶性，1例为多灶性；12例胰腺癌患者中，1例为弥漫性，11例为局灶性；两组相比差异有统计学意义（Fisher确切概率法，P〈0．01）。12例AIP患者在T1加权成像上，9例病变区信号降低，2例信号降低不明显，1例信号呈不均匀、略增高；在T2加权成像上，9例信号略增高，1例等信号，2例略低信号。AIP组病变组织ADC值为（1．011±0．118）^-3s／mm^2，低于正常胰腺组的（1．489±0．072）×10^-3s／mm^2和胰腺癌组的（1．274±0．120）×10^-3s／mm^2，差异均有统计学意义（t=-11．793、-4．300，P均〈0．01）。12例AIP患者中，4例可见病变区胰管呈节段性不规则硬化狭窄，7例病变区胰腺周围可见假包膜征象；12例胰腺癌患者中，2例病变区胰管狭窄，无假包膜征象；两组相比差异均有统计学意义（Fisher确切概率法，P均〈0．01）。动态增强MRI显示，AIP病变区和胰腺癌组织强化模式均为渐进性强化，但平衡期AIP组信号强度比值为3．34±1．40，明显高于胰腺癌组的2．38±0．18，差异有统计学意义（F=60．703，P〈0．01）。结论MRI多序列联合应用有助于全面反�Objective To investigate the diagnosis and differential diagnosis value of muhi- sequences magnetic resonance imaging （MRI） in autoimmune pancreatitis （ALP）. Methods The MRI data of twelve AIP patients were retrospectively analyzed. The sequences of MRI included Tl-weighted imaging, T2-weighted imaging, magnetic resonance cholangiopancreatography （MRCP）, diffusion- weighted imaging （DWI） and dynamic enhancement images. The location and involving extent of lesions, signal, patterns of dynamic enhancement, changes of pancreatic and biliary duct, pseudo-capsule sign and other accompanying signs were observed. Twelve pancreatic cancer patients and twelve other patients with normal pancreas were set as controls. The imaging signs of AIP group and pancreatic cancer group were compared with Fisherts exact test. On the sequence of DWI, the apparent diffusion coefficient （ADC） values of pancreatic interested region of the three groups were tested and compared with least significant difference t test. At each period of enhanced MRI, the intensity ratios of pancreatic interested region to theleft paraspinal muscle at the same level of the three groups were measured and compared with Pillai^s Trace test. Results Among 12 patients with AIP, seven were diffused lesion, four were localized lesion, and one was multiple lesions. Among 12 pancreatic cancer patients, one was diffused lesion, and eleven were localized lesion. The difference of these two groups was statisfically significant （Fisherts exact test, P〈0.01）. Among 12 AIP patients, on the Tl-weighted image, intensity decreased in nine lesions, two cases without obvious intensity decreasing, and one case unevenly increased. On the T2-weighted image, intensity slightly increased in nine lesions, equal in one case, and slightly lowered in two cases. The ADC value of the lesions of AIP group （（1.011±0.118）×10^-3s/mm^2） was lower than that of normal pancreas group （（1. 489±0. 072） ×10^-3s/mm^2 ） and pancreatic cancer group （（1.

关 键 词：胰腺炎 自身免疫疾病 磁共振成像 

分 类 号：R576[医药卫生—消化系统]