1.0T开放式磁共振引导经皮同轴胰腺病变穿刺活检的初步应用  

Preliminary application of 1.0T open MR-guided percutaneous coaxial needle biopsy of pancreatic lesions

作　　者：刘超[1] 朱丽萍 张克宁 何祥萌 柳明 许玉军 董青[1] 邱红梅[1] 李成利 LIU Chao;ZHU Liping;ZHANG Kening;HE Xiangmeng;LIU Ming;XU Yujun;DONG Qing;QIU Hongmei;LI Chengli(Department of Minimally Invasive Therapy of Tumor,Tai'an Municipal Central Hospital,Tai'an,Shandong Province 271000,China)

机构地区：[1]泰安市中心医院肿瘤微创科,山东271000 [2]寿光市中医院 [3]平度市中医院 [4]山东大学附属山东省医学影像学研究所

出　　处：《介入放射学杂志》2019年第11期1081-1086,共6页Journal of Interventional Radiology

摘　　要：目的优化选择1.0 T开放式MR引导经皮同轴胰腺病变穿刺活检的多模态序列及评估其可行性、准确性和安全性。方法 2016年1月至2018年3月,42例胰腺病变患者,采用开放式1.0 T高场强磁共振扫描仪引导下经皮同轴切割针穿刺活检操作。术前增强CT或MR评估,19例胰头病变(19/42, 45.2%),10例胰体病变(10/42, 23.8%), 13例胰尾病变(13/42, 31.0%),病变最长径平均(2.9±0.8) cm(2.0~5.3 cm)。局麻下,MR扫描联合鱼油胶囊矩阵定位网格确定活检针穿刺入路点并引导穿刺。T2WI-TSE(Turbo Spin Echo T2加权序列)用于病灶定位;PD-TSE(Turbo Spin Echo prodensity加权序列)进行穿刺过程中显示穿刺针方向和实际针尖的位置;增强扫描T1WI-TFE(Turbo Field Echo T1加权序列)在需要区分病灶及坏死灶时,作为互补序列确定穿刺靶区;活检后10 min内,采用脂肪抑制T2WI-TSE序列扫描确认是否存在术后并发症发生。通过手术和临床随访至少12个月确认最终诊断。计算准确率、灵敏度和特异度,记录并发症。结果 1.0 T MR多模态序列扫描引导与监控下,对全组42例患者均成功实施穿刺活检,获取的样本足以用于组织病理学诊断。穿刺活检病理显示34例(80.9%)患者为恶性胰腺肿瘤,8例(19.1%)为良性胰腺病变。经手术和临床随访证实,37例诊断为胰腺恶性肿瘤,5例为良性疾病,3例活检结果为假阴性。活检诊断准确率92.9%(39/42),灵敏度91.9%(34/37),特异度100%,阳性预测值100%,阴性预测值62.5%。全部患者穿刺活检耐受良好,3例患者在手术后出现轻微的胰周出血,未出现严重并发症。结论 1.0 T开放式高场强MR多模态序列引导与监控对胰腺病变经皮穿刺活检具有很高的诊断准确率,在临床实践中是可行和安全的。Objective To optimize the multimodal sequence of 1.0 T open MR-guided percutaneous coaxial needle biopsy of pancreatic lesions, and to evaluate its feasibility, accuracy and safety. Methods From January 2016 to March 2018, a total of 42 patients with pancreatic lesions underwent percutaneous coaxial cutting needle biopsy guided by 1.0 T high-field open MR scanner. Preoperative contrast-enhanced CT or MRI demonstrated that the pancreatic lesions were located at the head(n=19, 45.2%), at the body(n=10, 23.8%) or at the tail(n=13, 31%). The mean maximum longitudinal diameter of lesions was(2.9±0.8) cm(range of2.0-5.3 cm). Under local anesthesia, MRI scan combined with a fish-oil capsule matrix positioning grid was performed to determine the puncture point of biopsy needle and to guide the puncturing manipulation. Turbo Spin Echo T2-weighted sequence(T2 WI-TSE) was employed to localize lesions, and Turbo Spin Echo prodensity weighted sequence(PD-TSE) was used to display the direction of the puncture needle and the actual position of the needle tip during puncturing process. Contrast-enhanced Turbo Field Echo T1-weighted sequence(T1 WI-TFE) was adopted as a complementary sequence to determine the puncture target area when it was necessary to distinguish lesions from necrotic foci. Fat-suppressed T2 WI-TSE sequence was performed within 10 minutes after biopsy to confirm if there were any postoperative complications. The final diagnosis was made by surgical evidence and clinical follow-up findings(at least 12 months). The diagnostic accuracy,sensitivity and specificity were calculated, and the complications were recorded. Results Under the guidance and monitoring of 1.0 T MR multimodal sequence scanning, needle biopsy was successfully accomplished in all 42 patients, and all the tissue samples thus obtained were sufficient for histopathological diagnosis.Pathological examination of puncture biopsy showed that malignant pancreatic tumor was found in 34 patients(80.9%) and benign pancreatic lesion was seen in 8 patients(

关 键 词：磁共振引导 介入放射学 胰腺占位 

分 类 号：R735.9[医药卫生—肿瘤]