MR 扩散加权成像在自身免疫性胰腺炎鉴别诊断及疗效评估中的价值  

Preliminary application of MR diffusion weighted imaging in the diagnosing and evaluating therapeutic effect of autoimmune pancreatitis

作　　者：张加成[1] 张晨[2] 杨正汉[2] 唐维林[3] 方金洲 徐忠飞[5] 谭晔[2] 朱捷[2] 陈敏[2] 周诚[2] 

机构地区：[1]浙江省中西医结合医院暨杭州市红十字会医院放射科,杭州310003 [2]北京医院暨北京大学第五临床医学院放射科 [3]齐齐哈尔医学院第一附属医院放射科 [4]浙江省衢州市衢化医院放射科 [5]浙江省台州市中心医院放射科

出　　处：《中华放射学杂志》2014年第6期484-488,共5页Chinese Journal of Radiology

基　　金：北京市自然科学基金资助项目（7102138）

摘　　要：目的：探讨MR DWI在自身免疫性胰腺炎（ AIP）鉴别诊断及疗效评估中的价值。方法回顾性分析26例AIP、29例胰腺癌（PC）及30例胰腺正常（NP）患者的DWI资料。观察病灶的分布类型及信号特点，测量病灶或组织的ADC值。 AIP与PC组患者病灶分布类型及信号特点的比较采用χ2检验。各组病灶或组织ADC值的比较采用秩和检验。对AIP组及PC组病灶的ADC值行ROC曲线分析，确定诊断最佳阈值及诊断效能。15例AIP患者行类固醇激素治疗，测量激素治疗前后病灶的ADC值，并采用配对t检验进行比较。结果 AIP组26例中，21例病灶呈弥漫型分布，5例呈局限型分布。 PC组29例中，3例病灶呈弥漫型分布，26例呈局限型分布，病灶分布差异有统计学意义（χ2＝27.64，P＜0.01）。 AIP病灶在DWI上有19例呈高信号，7例呈等信号。 PC病灶24例呈高信号，5例呈等信号，信号强度差异无统计学意义（χ2＝0.75，P＞0.05）。 AIP、PC和NP患者的胰腺病灶或组织的ADC值中位数分别为1.15×10-3、1.35×10-3、1.59×10-3 mm2/s，差异有统计学意义（ H＝45.60，P＜0.01）。 AIP与PC鉴别诊断的ADC最佳阈值为1.255×10-3 mm2/s，诊断AIP的敏感度和特异度分别为80.8％（21/26）和79.3％（23/29），曲线下面积为0.871。15例AIP组患者类固醇激素治疗前、后的ADC值分别为（1.10±0.19）×10-3和（1.57±0.12）×10-3 mm2/s，差异有统计学意义（t＝-10.14，P＜0.01）。结论 DWI在AIP鉴别诊断及疗效评估中有一定价值。 AIP病灶ADC值低于胰腺癌和正常胰腺组织，经类固醇激素治疗后ADC值升高。Objective To investigate the role of DWI in differentiating autoimmune pancreatitis （ AIP） from pancreatic cancer （ PC） , and in the therapeutic effect evaluation of AIP.Methods DWI data of 26 cases with AIP , 29 cases with PC and 30 cases with normal pancreas （ NP ） were analyzed retrospectively.The distribution type and signal feature of lesions in cases with AIP or PC were evaluated by Chi-squared test.ADC values were measured and compared among 3 groups by Kruskal-Wallis test.ADC values of AIP and PC were analyzed by using ROC curve to determine the optimal threshold and diagnostic efficiency.ADC values were compared in AIP （ n=15 ） before and after steroid therapy by paired t test.Results Diffuse lesions were detected in 21 cases with AIP and 3 cases with PC, while focal lesions in 5 cases with AIP and 26 cases with PC （χ2 =27.64, P0.05）.The median ADC values of AIP, PC and NP were 1.15 ×10 -3,1.35 ×＆nbsp;10 -3 ,1.59 ×10-3 mm2/s, respectively; and the difference was statistically significant （ H=45.60, P 〈0.01）.ROC analysis yielded an optimal ADC cutoff value of 1.255 ×10 -3 mm2/s （80.8% sensitivity, 79.3%specificity and 0.871 area under curve for the diagnosis of AIP ）.ADC values of AIP （ n=15） were markedly increased from the baseline （1.10 ±0.19） ×10 -3 to （1.57 ±0.12） ×10 -3 mm2/s after steroid therapy （t=-10.14, P〈0.01）.Conclusions DWI may be useful for diagnosing and evaluating the effect of steroid therapy in AIP.ADC values of AIP were significantly lower than those of pancreatic cancer and normal pancreas.After steroid therapy , ADC values were markedly increased in AIP.

关 键 词：胰腺肿瘤 胰腺炎 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R576[医药卫生—诊断学]