肠型与胰胆管型壶腹周围癌磁共振征象的对比观察  

Contrastive study on MRI signs of intestinal and pancreatobiliary-type periampullary carcinoma

作　　者：祝琼洁 何健[2] 黎琪[3] 严陈晨[1] Zhu Qiongjie;He Jian;Li Qi;Yan Chenchen(Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院医学影像科,南京210008 [2]南京大学医学院附属鼓楼医院核医学科,南京210008 [3]南京大学医学院附属鼓楼医院病理科,南京210008

出　　处：《中华医学杂志》2022年第18期1351-1358,共8页National Medical Journal of China

摘　　要：目的比较分析肠型壶腹周围癌(IPAC)与胰胆管型壶腹周围癌(PPAC)的磁共振成像(MRI)征象特点, 探讨最优诊断方案。方法回顾性分析南京鼓楼医院2017年1月至2020年7月, 经手术病理确诊为壶腹周围癌(PAC)59例患者(男32例, 女27例, 年龄37~80岁)的术前MRI图像, 将病灶根据组织病理结果分为IPAC组21例(男 11例, 女10例)和PPAC组38例(男 21 例, 女17例)。纳入分析的MRI常规平扫图像征象包括:病灶形态、病灶最大径、病灶位置、十二指肠乳头形态、平扫病灶信号(以正常胰腺信号作为参照)、弥散加权成像(DWI)信号。磁共振胰胆管水成像(MRCP)图像征象包括:胆总管及主胰管是否扩张及管径定量分析、胆总管远端内有无类圆形充盈缺损、胆总管狭窄形态、梗阻胰管周围是否有扩张侧支、管征、截断胆总管末端到十二指肠乳头距离、截断胰管末端到十二指肠乳头距离和胰胆管角度。采用受试者工作特征(ROC)曲线评价有意义单因素的诊断效能。依据有意义的单因素指标, 总结PAC的MRI征象特点, 将PAC的MRI征象特征归纳为影像5分型。并采用ROC曲线评价该分型标准对PAC病理亚型的诊断效能。采用DeLong 检验比较多种诊断方法的ROC 曲线下面积(AUC)。结果在单因素分析中, IPAC与PPAC在病灶位置、十二指肠乳头形态、胆总管远端内类圆形充盈缺损、截断胰管末端到十二指肠乳头距离、胰胆管角度和平扫T_(2)加权成像(T_(2)WI)脂肪抑制图像上病灶信号特点间的差异均有统计学意义(均P<0.05)。在MRI影像5分型中, IPAC多表现为十二指肠乳头结节型(15/21, 71.4%), PPAC更多表现为胰腺肿块型(18/38, 47.4%)、胆总管壁增厚型(9/38, 23.7%)或壶腹部肿块型(9/38, 23.7%), IPAC(2/21, 9.5%)与PPAC(0, 0)均较少表现为胆总管腔内结节型。在有意义单因素指标(病灶位置、十二指肠乳头形态、胆总管远端内类圆形充盈缺损、截断胰�Objective The magnetic resonance imaging(MRI)features of intestinal-type periampullary carcinoma(IPAC)and pancreatobiliary-type periampullary carcinoma(PPAC)were compared and analyzed to discuss the optimal diagnosis scheme.Method Preoperative MRI images of 59 patients(32 males,27 females,aged 37-80 years)diagnosed with periampullary carcinoma(PAC)confirmed by surgery and pathology in Nanjing Drum Tower Hospital from January 2017 to July 2020 were retrospectively analyzed.The patients were divided into 21 cases in the IPAC group(11 males,10 females)and 38 cases in the PPAC group(21 males,17 females)according to histopathological results.The conventional MRI plain scan signs included in the analysis include lesion morphology,the largest diameter of the lesion,lesion location,duodenal papilla morphology,plain scan lesion signal(with the normal pancreatic signal as reference),diffusion weighted imaging(DWI)signal.Magnetic resonance cholangiopancreatography(MRCP)image signs include the dilatation of common bile duct and main pancreatic duct and quantitative analysis of their diameter,the presence of a round filling defect in the distal end of the common bile duct,the morphology of common bile duct stenosis,the dilatation of lateral branches around the obstructed pancreatic duct,the ductal sign,the distance from the end of the obstructed common bile duct to the duodenal papilla,the distance from the end of the obstructed pancreatic duct to the duodenal papilla,and the angle of the pancreaticobiliary duct.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of single meaningful factors.The MRI features of PAC were summarized according to the significant single factor indicators and were classified into 5 image types.And the diagnostic efficacy of the classification criteria for pathological subtypes of PAC was evaluated by the ROC curve.The DeLong test was used to compare the area under the ROC curve(AUC)of multiple diagnostic methods.Results In univariate analysis,there were sta

关 键 词：十二指肠肿瘤 壶腹周围癌 肠型壶腹周围癌 胰胆管型壶腹周围癌 核磁共振 诊断 

分 类 号：R735[医药卫生—肿瘤] R445.2[医药卫生—临床医学]