MRI对自身免疫性胰腺炎的诊断与鉴别诊断价值  

Diagnosis and differential diagnosis value of MRI for autoimmune pancreatitis

作　　者：潘鸿[1] 岑峰[2] 

机构地区：[1]浙江省海宁市人民医院放射科,浙江海宁314400 [2]浙江省湖州市中心医院普外科,浙江湖州313000

出　　处：《中国现代医生》2015年第23期118-121,F0003,共5页China Modern Doctor

基　　金：浙江省医学会临床科研资金项目(2009zyc35)

摘　　要：目的探讨MRI对自身免疫性胰腺炎的诊断与鉴别诊断价值。方法选择2010年2月~2014年4月我院收治的16例自身免疫性胰腺炎患者为AIP组,另选择同期确诊胰腺癌患者15例和体检健康者15例作为PC组和正常对照组,比较各组MRI学征象,并对比AIP组MRI和CT征象。结果自身免疫性胰腺炎以弥漫性肿大为主,抑脂T1WI信号强度降低,抑脂T2WI信号强度升高,动脉期呈＂雪花状＂不均匀低强化,延迟强化,环绕假包膜并伴不同程度胆管和胰管改变。MRI与CT的征象在平扫信号分布、延迟强化、胰管狭窄、假包膜的判断上有显著性差异,MRI诊断AIP优于CT（P〈0.05）。AIP与PC的MRI征象在范围、平扫信号分布、动脉期强化、胰管改变、假包膜的MRI征象上差异有统计学意义（P〈0.05）,动脉期＂雪花样＂不均匀低强化、假包膜是AIP特征。AIP组、PC组和正常对照组在动态增强各期感兴趣区信号强度比值差异有统计学意义（P〈0.05）。AIP组ADC值最低,AIP、PC的鉴别ADC值为（1.139×10-3）mm2/s,ROC曲线下面积为0.873,灵敏度和特异度分别为83.12%和79.28%。结论 MRI平扫、动态增强、MRCP、DWI多序列联合诊断AIP较CT有明显优势,有助于提高诊断和鉴别诊断准确性。Objective To investigate the diagnosis and differential diagnosis value of MRI for autoimmune pancreatitis. Methods Sixteen patients with autoimmune pancreatitis treated in our hospital from February 2010 to April 2014 were assigned to the AIP group, and 15 patients diagnosed with pancreatic cancer and 15 healthy people in the correspond- ing period were assigned to the PC group and the normal control group. MRI signs of each group were compared and MRI and CT signs of the AIP group were compared. Results Autoimmune pancreatitis mainly manifested as diffuse en- largement, reduced fat-suppressed TIWI signal, elevated fat-suppressed T2WI signal,＂snowflake-like＂ uneven low en- hancement in arterial phase, delayed enhancement, surrounding pseudocapsule and varying degrees of bile duct and pancreatic duct changes. MRI and CT signs were significantly different in the plain scan signal distribution, delayed enhancement, pancreatic duct stenosis and diagnosis of pseudocapsule, and MRI was better than CT in the diagnosis of AIP （P〈0.05）. AlP and PC were significantly different in the MRI signs, including range, plain scan signal distribution, arterial phase enhancement, pancreatic duct change and pseudocapsule （P〈0.05）, and ＂snowflake-like＂ uneven low en- hancement in dynamic phase and pseudocapsule were AIP features. The AlP group, PC group and normal control group were significantly different in the signal intensity rates in the interested areas of each dynamic enhancement stage（P〈 0.05）. The AIP group had the lowest ADC value, and AIP and PC had a differential ADC value of （1.139×10^-3） mm^2/s, ROC of 0.873, and sensitivity and specificity of 83.12% and 79.28%. Conclusion Diagnosis combining MRI plain scan, dynamic enhancement, MRCP and DWI multi sequence has obvious advantages over CT and is conducive to improving the accuracy of diagnosis and differential diagnosis.

关 键 词：自身免疫性胰腺炎 磁共振成像 胰腺肿瘤 诊断 

分 类 号：R816.5[医药卫生—放射医学]