MRI影像学检查在胰腺导管内乳头状黏液性肿瘤相关性浸润癌中的应用价值  

MRI Imaging in Intraductal Papillary Mucinous Neoplasm-associated Invasive Carcinoma of the Pancreas

作　　者：吴志涛 薛蕴菁[2] Wu Zhitao;Xue Yunjing(Imaging Department,The Second Hospital of Nanping City,Nanping,Fujian 354200;Department of Imaging,Union Hospital Affiliated to Fujian Medical University,Fuzhou,Fujian 350001)

机构地区：[1]南平市第二医院影像科,福建南平354200 [2]福建医科大学附属协和医院影像科,福建福州350001

出　　处：《现代医用影像学》2022年第12期2193-2197,共5页Modern Medical Imageology

摘　　要：目的:利用磁共振对胰腺导管内乳头状黏液性肿瘤相关性浸润癌周围浸润性的判断,其准确性及临床价值。方法:回顾性分析我院及福建医科大学附属协和医院2016-2021年经手术切除及病理证实的40例IPMN患者资料,术前行MRI检查。分析影像学病变部位、导管累及类型、病变形状、病变直径、主胰管扩大程度、胆总管扩大程度、壁结节改变与IPMN相关性浸润癌发生的关系,分析MRI影像学检查预测IPMN相关浸润癌中的临床应用价值。结果:40例IPMN病例中,12例病理证实为IPMN相关浸润癌。病变主要与导管累及类型、病变的形态、胆总管的扩张程度、壁结节等与IPMN相关浸润癌发病密切有关。囊实性肿块预测侵袭性IPMN的灵敏性和特异性分别为66.7%(8/12)和80.0%(8/10)。胆总管扩大预测侵袭性IPMN的灵敏性和特异性分别为50%(6/12)和80%(8/10)。病变部位与IPMN相关浸润癌的发生无相关性(P=0.803)。IPMN浸润癌患者的主胰管直径大于无浸润癌患者。主胰管直径≥5mm预测浸润性IPMN的灵敏性和特异性分别为92%(11/12)和43%(3/7)。对于分支型和混合型IPMN患者,浸润性癌的病变直径大于非浸润性癌。当主胰管最大径≥8mm时,其预测浸润性IPMN的灵敏性为75%(9/12),特异性为86%(6/7);当主胰管最大径≥10mm时,其预测浸润性IPMN的灵敏性为25%(3/12),特异性为100%(7/7)。结论:MRI影像学特征可以帮助预测IPMN相关的浸润性癌,在指导治疗、制定手术方案、预测患者预后等方面具有重要的临床价值。Objective:To evaluate the peripheral invasion of intraductal papillary mucinous neoplasm-associated invasive carcinoma of the pancreas by magnetic resonance imaging(MRI),its accuracy and clinical value.Methods:Data of 20 patients with IPMN who were surgically resectomized and pathologically confirmed in our hospital from 2014 to 2021 were retrospectively analyzed,and PREOPERATIVE MRI examination was performed.The relationship between imaging lesion site,type of ductal involvement,lesion shape,lesion diameter,degree of enlargement of main pancreatic duct,degree of common bile duct and the occurrence of IPMn-related invasive carcinoma was analyzed,and the clinical application value of MRI imaging in predicting IPMn-related invasive carcinoma was analyzed.Results:Among the 40 cases of IPMN,12 cases were pathologically confirmed as IPMn-related invasive carcinoma.The lesions were closely related to the types of duct involvement,morphology,dilation of common bile duct,mural nodules and ipMn-related invasive carcinoma.The sensitivity and specificity of predicting invasive IPMN by cystic solid mass were 66.7%(8/12)and 80.0%(8/10),respectively.The sensitivity and specificity of common bile duct enlargement in predicting invasive IPMN were 50%(6/12)and 80%(8/10),respectively.There was no correlation between the lesion site and the occurrence of IPMn-associated invasive carcinoma(P=0.803).The diameter of main pancreatic duct in patients with IPMN invasive carcinoma was larger than that in patients without invasive carcinoma.The sensitivity and specificity for predicting invasive IPMN were 92%(11/12)and 43%(3/7),respectively.For patients with branching and mixed IPMN,the lesion diameter of invasive carcinoma was larger than that of non-invasive carcinoma.When the maximum diameter of the main pancreatic duct was≥8mm,the sensitivity and specificity for predicting invasive IPMN were 75%(9/12)and 86%(6/7),respectively.When the maximum diameter of the main pancreatic duct was≥10mm,the sensitivity of predicting invasive IPMN

关 键 词：胰腺肿瘤 导管内乳头状黏液性肿瘤 磁共振成像 

分 类 号：R735.9[医药卫生—肿瘤] R445.2[医药卫生—临床医学]