自身免疫性胰腺炎治疗前后的磁共振评价  

Evaluation of magnetic resonance imaging in autoimmune pancreatitis before and after treatment

作　　者：陈悦熙[1] 曾伟科[2] Chert Yuexi;Zertg Weike(Department of Radiology, the Twelfth People＇s Hospital of Guangzhou, Guangzhou 510620, China;Department of Radiology, Sun Yat-sert Memorial Hospital, Sun Yat-sen Urtiversity, Guangzhou 510120, China)

机构地区：[1]广州市第十二人民医院放射科,510620 [2]中山大学孙逸仙纪念医院放射科,广州510120

出　　处：《中华核医学与分子影像杂志》2018年第4期252-256,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：广州市卫生和计划生育科技项目（20161A011043）;广东省科技计划项目（20138021800222）

摘　　要：目的评价自身免疫性胰腺炎（AIP）的MRI影像特征及MR在治疗前后的价值。方法回顾性分析2013年1月至2015年12月间20例AIP患者[男14例、女6例；平均年龄（54.0±10.3）岁]MRI资料，包括T1加权成像（WI）、T2WI、磁共振胰胆管成像（MRCP）、扩散加权成像（DWI）和动态增强显像，其中15例AIP激素治疗后复查DWI。观察病变累及部位、范围、信号及动态强化方式，有无＂假包膜＂征及其他伴随征象。比较治疗前后MRI评价指标差异；测量病变部位表观扩散系数（ADC），比较治疗前后DWI表现。采用χ^2检验和配对t检验分析数据。结果20例患者中，5例经组织病理学证实，15例经临床综合指标及激素规范治疗随访证实。MRI表现上，16例表现为胰腺弥漫性增大，4例表现为胰腺局限性肿大；病变胰腺T1WI呈低信号，T2WI呈高信号；12例胰周见＂假包膜＂征；动态增强扫描胰腺病变部呈延迟强化；MRCP示10例胆总管胰头段狭窄，胰管不规则狭窄。15例患者MRI胰腺形态、病变信号、＂假包膜＂征及强化程度均较治疗前有明显好转或改善（χ^2值：5.000～22.941，均P〈0.05）。治疗前DWI可见胰腺病灶均呈高信号，治疗后DWI示胰腺实质信号减低；ADC明显高于治疗前[（1.27±0.14）×10^－3和（1.05±0.16）×10^－3 mm^2/s；t＝4.15，P〈0.01]。结论DWI有助于反映AIP的病理学和生物学特性，可评估AIP患者疗效。ObjectiveTo evaluate the imaging features of MRI in autoimmune pancreatitis （AIP） and analyze the diagnostic value before and after treatment.MethodsMRI data of 20 AIP patients （14 males, 6 females; average age： （54.0±10.3） years） from January 2013 to December 2015 were retrospectively analyzed. The sequences of MRI included T1 weighted imaging （WI）, T2WI, MR cholangiopancreatography （MRCP）, diffusion weighted imaging （DWI） and dynamic enhancement images. Fifteen of the patients received DWI again after hormone therapy. The location and extent of lesions, signal, patterns of dynamic enhancement, ＂ pseudocapsule＂ sign and other accompanying signs, the apparent diffusion coefficient （ADC） of the lesion and the DWI manifestations before and after treatment were observed, calculated and compared. χ^2 test and paired t test were used to analyze the data.ResultsFive patients were confirmed by pathology and 15 by clinical follow-up. In MRI, 16 patients appeared diffusive swollen pancreases, and 4 patients were with focal enlargement. Lesions of pancreas showed low signal on T1WI and high signal on T2WI. Twelve patients presented ＂ pseudocapsule＂ around the lesions and progressive enhance was shown in the delayed phase on dynamic contrast enhanced MRI. Ten patients showed stenotic choledoch in the head of pancreas and segmented stenotic pancreatic duct in MRCP. All pancreatic lesions in the 10 patients presented high signals on DWI. The pancreatic morphology, the signal of the lesion, the ＂ pseudocapsule＂ sign and the enhancement degree on MRI were significantly improved compared with those before treatment in 15 patients （χ^2 values： 5.000-22.941, all P〈0.05）. After hormone therapy, the signals on DWI were markedly weakened in pancreatic parenchyma, and ADC was significantly higher than that before treatment （（1.27±0.14）×10^-3vs （1.05±0.16）×10^-3 mm^2/s; t=4.15, P〈0.01）.ConclusionDWI could reflect the pathological and biological characteristics of AI

关 键 词：胰腺炎 慢性 自身免疫疾病 磁共振成像 治疗结果 

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]