MRI联合序列检查在壶腹周围癌鉴别诊断中的价值  

Differential diagnosis of vater ampulla carcinoma with MRI combined sequence examination

作　　者：陈晓煜[1,2] 印隆林[1,2] 谢欢[1,3] 苟文枭 王富民[1,2] 

机构地区：[1]电子科技大学附属医院·四川省人民医院放射科,四川成都610072 [2]电子科技大学医学院,四川成都610000 [3]西南医科大学医学影像系,四川泸州646000

出　　处：《实用放射学杂志》2017年第6期561-565,共5页Journal of Practical Radiology

摘　　要：目的 探讨MRI联合序列检查在壶腹周围癌（VPC）鉴别诊断中的价值。 方法 回顾性分析53例经手术病理证实的VPC患者的MRI资料（壶腹癌17例、胰头癌15例、十二指肠乳头癌10例、胆总管下段癌11例），所有患者均行常规上腹部MRI平扫、磁共振胰胆管成像（MRCP）及多期动态增强扫描，重点观察分析肿瘤的形态学特征、动态强化特点、胰胆管形态学改变并测量相关数据。 结果 4组VPC在大小、中心位置及信号均匀性方面总体存在差异性（P〈0.05），其动态强化特点也存在差别；VPC最常出现“双管征”（26/53），胰头癌易出现“四管征”（8/15），胆总管下段癌易出现“三管征”（8/11）；“鸟嘴征”多见于壶腹癌（10/17），“鼠尾征”多见于胰头癌（7/15），“截断征”多见于胆总管下段癌（10/11）；胰头癌组主胰管直径最大、胆总管下段癌组最小且其差异有统计学意义（P〈0.05）；胰头癌组和胆总管下段癌组的胆总管梗阻末端及主胰管梗阻末端到十二指肠主乳头的距离、胰胆管汇合角度均大于壶腹癌组及十二指肠乳头癌组。 结论 MRI联合序列检查能较好显示不同组织学来源VPC的影像学特征，综合分析这些特征有助于胰头壶腹区肿瘤组织学类型的鉴别。Objective To investigate the value of multiple sequential MRI in the differential diagnosis of rater ampulla carcinoma （VPC}. Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively, which included 17 ampullary carcinomas, 15 pancreatic head carcinomas, 10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas. All patients underwent routine MRI plain scan, MRCP and multi-phase dynamic enhancement scan for the upper abdomen-The morphological characteristics and model of multi-phase dynamic enhancement of the tumor, and the morphological changes of pancreaticobiliary duct were focused, and relevant data were also measured. Results The differences of tumor size, central location, and signal homogeneity among the four different histological types showed statistical significance（P d0.05）, and their patterns of multi-phase dynamic enhancement also had differences. ＂Double-segment＂ sign was most found in VPC （26/53）, ＂four-segment＂ sign was easy showed in pancreatic head carcinoma （8/15 ） and ＂three-segment＂ sign in distal common bile duct carcinoma （8/11）.＂Beak＂ sign was common seen in ampullary carcinoma（10/17）, ＂rat-tail＂ sign was easy discovered in pancreatic head carcinoma （7/15） and ＂truncated＂ sign in distal common bile duct carcinoma（10/11）.Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma, and their difference had statistical significance（P〈0.05）. Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma. Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological

关 键 词：壶腹癌 胰腺癌 十二指肠乳头癌 胆管癌 磁共振成像 

分 类 号：R735.9[医药卫生—肿瘤] R735.31[医药卫生—临床医学]