胰腺癌淋巴结转移3．0T磁共振弥散加权成像诊断  

3.0T magnetic resonance diffusion weighted imaging diagnosis of pancreatic cancer with lymph node metastasis

作　　者：方旭[1] 边云[1] 王莉[1] 陆建平[1] 

机构地区：[1]第二军医大学附属长海医院影像医学科,上海200433

出　　处：《中华胰腺病杂志》2017年第5期311-315,共5页Chinese Journal of Pancreatology

基　　金：上海申康医院发展中心临床科技创新项目（SHDC22015035）;上海科技委员会医学引导类科技计划基金资助项目（14411960100）

摘　　要：目的探讨术前3.0T磁共振弥散加权成像（DWI）对胰腺癌淋巴结转移的诊断价值。方法选取病理确诊为胰腺癌且有淋巴结转移的患者30例，术前均进行磁共振DWI检查。以日本胰腺病学会2002年制定的第5版TNM分期为淋巴结分组标准，分析转移淋巴结的部位，测量淋巴结表观扩散系数（ADC）值和最大短轴直径（MSAD），采用受试者工作特征（ROC）曲线评估ADC值和MSAD对胰腺癌淋巴结转移的诊断价值。结果DWI检查共明确淋巴结108枚，其中转移淋巴结54枚，非转移淋巴结54枚。胰头癌转移淋巴结的位置以第13组、16组、17组多见，胰体尾癌以第16组多见。转移淋巴结ADC值明显低于非转移淋巴结ADC值[（1.51±0.28）×10－3mm2/s比（2.08±0.35）×10－3mm2/s]，转移淋巴结MSAD长于非转移淋巴结MSAD[（7.03±2.49）mm比（4.40±0.97）mm]，差异均有统计学意义（P值均〈0.001）。ADC值诊断转移淋巴结的ROC曲线下面积为0.894，最佳阈值为1.78×10－3mm2/s，敏感性和特异性分别为85.2%、85.2%；MSAD诊断转移淋巴结的ROC曲线下面积为0.876，最佳阈值为5.65 mm，敏感性和特异性分别为68.5%、90.7%。结论3.0T磁共振DWI对胰腺癌淋巴结转移有较高的诊断价值。ObjectiveTo explore the diagnostic value of 3.0T MR diffusion weighted imaging（DWI） for metastatic lymph nodes in pancreatic cancer.MethodsThirty patients who were pathologically diagnosed as pancreatic cancer with metastatic lymph nodes were enrolled and all underwent preoperative routine MR DWI examination. TNM staging version 5.0 by JPA in 2002 was used as the grouping criteria for lymph node, and the location of metastatic lymph nodes was analyzed. Apparent diffusion coefficient （ADC） and maximum short axis diameter （MSAD） of lymph nodes were measured, and receiver operating characteristic （ROC） curve was drawn to evaluate the diagnostic value of ADC and MSAD for pancreatic cancer with metastatic lymph nodes.ResultsThe number of lymph nodes was 108 detected by DWI including 54 metastatic lymph nodes and 54 non-metastatic lymph nodes. The metastatic lymph nodes most commonly occurred in group 13, 16 and 17 in pancreatic head cancer and group 16 in pancreatic body and tail cancer. The ADC value of metastatic lymph nodes was lower than that of non-metastatic lymph nodes [（1.51±0.28）×10-3 mm2/s vs （2.08±0.35）×10-3 mm2/s]. The MSAD of metastatic lymph nodes was longer than that of non-metastatic lymph nodes [（7.03±2.49）mm vs （4.40±0.97）mm]. There were statistically significant differences （all P〈0.001）. The areas under the ROC curve of ADC values was 0.894, the best threshold was 1.78×10-3mm2/s, and the corresponding sensitivity and specificity was 85.2% and 85.2%. The areas under the ROC curve of MSAD was 0.876, the best threshold was 5.65 mm, and the corresponding sensitivity and specificity was 68.5% and 90.7%.Conclusions3.0T MR DWI had a relatively high diagnostic value for metastatic lymph nodes in pancreatic cancer.

关 键 词：胰腺肿瘤 淋巴结 肿瘤转移 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.9[医药卫生—诊断学]