壶腹部浸润性腺癌的MRI诊断与临床应用  

The diagnosis and clinical value of MRI for invasive adenocarcinoma of the ampullary region

作　　者：吴元华[1] 王玉涛[1] 吴盛赞 丁前江 汪建华[1] 邓生德[1] 张建[2,3] 

机构地区：[1]宁波大学医学院附属医院影像科,浙江宁波315020 [2]上海全景医学影像诊断中心,上海200233 [3]第二军医大学附属长海医院核医学科,上海200433

出　　处：《医学影像学杂志》2017年第3期497-501,共5页Journal of Medical Imaging

基　　金：浙江省医药卫生科技计划项目(编号:2014KYB238);浙江省宁波市自然科学基金(编号:2015A610201)

摘　　要：目的探讨壶腹部浸润性腺癌(invasive adenocarcinoma of the ampullary region,IAAR)的MRI影像学特征及其临床应用价值。方法回顾性分析22例经病理证实的IAAR患者的MRI检查资料。22例患者均行MRI平扫,其中19例行DWI扫描,19例行MRCP扫描,17例行MR增强扫描。观察病灶的大小、形态、边界、生长方式、内部结构、信号、强化模式及胆总管、主胰管改变等。结果 1)T1WI均表现为等或稍低信号,T2WI 10例呈等信号,12例呈等高信号,DWI18例呈稍高、高信号;增强扫描呈持续性轻度强化。20例伴胆总管扩张、11例伴主胰管扩张;10例侵犯胰腺,5例发生肝转移,8例伴周围淋巴结肿大;2)MRI平扫结合DWI、MRCP、LAVA扫描的定位、定性准确率分别为94.7%(18/19)、89.5%(17/19)、94.1%(16/17)。平扫、DWI、MRCP和LAVA多序列联合诊断IAAR准确率为95.5%(21/22)。结论MRI利用其超高组织分辨率、多角度成像及MRCP、DWI、LAVA等多序列联合检查,能较全面、准确地显示Vater壶腹部细节结构,对IAAR的诊断具有重要价值。Objective To investigate the magnetic resonance imaging （MRI） features of invasive adenocarcinoma of the amp- ullary region （IAAR） and its clinical application. Methods MRI of 22 patients with IAAR proved by pathology were analyzed retrospectively. 22 patients underwent plain MRI, of whom 19 underwent DWI scan, 19 underwent MRCP scan, and 17 under- went dynamically enhanced MR scan. Observation indictors included tumor size, shape, growth pattern, boundary, internal struc- ture, signal, style of contrast enhancement, changes of bile and / or pancreatic duct. Results 1 ） All tumors showed slightly lower or equal signal on T1WI and 10 cases showed equal signal, 12 eases showed equal and high signal on T2WI. 18 cases showed high signal on DWI. Enhancement pattern appeared slightly enhancement. 20 cases presented with common bile duct dila- tion and 11 cases with main pancreatic duct dilation, pancreas invaded was shown within 10 cases and hepatic metastasis was shown within 5 cases, 8 cases showed Peripheral lymphadenectasis; 2） MRI plain scan combined with DWI, MRCP and LAVA sequences, showed the positioning diagnosis and qualitative diagnosis accuracy rate of 94. 7% （ 18/19 ）, 89.5% （ 17/19 ）, 94. 1% （16/17）, respectively. MRI plain scan combined with DWI, MRCP and LAVA sequences, showed the diagnosis accuracy rate of IAAR of 95.5% （21/22）. Conclusion MRI using higher tissue resolution, multi angle imaging and multi sequences like DWI, MRCP, LAVA, could commendably reveal the details of the ampullary region. MRI has significant value to the diagnosis of IAAR.

关 键 词：壶腹部肿瘤 浸润性腺癌 磁共振成像 

分 类 号：R736.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]