多种MR成像技术在胰腺癌诊断及其可切除性探讨  

The study of multiple MRI techniques in the diagnosis and assessment of resectability in pancreatic carcinoma

作　　者：龙玉[1] 孔祥泉[1] 徐海波[1] 刘定西[1] 杨帆[1] 熊茵[1] 于群[1] 彭振军[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《放射学实践》2003年第4期237-240,共4页Radiologic Practice

摘　　要：目的 :探讨多种MR成像技术对胰腺癌诊断及其手术可切除性判断的价值。方法 :1 8例经手术和 /或病理证实的胰腺癌患者进行了磁共振检查 ,采用的磁共振序列分别为 :GRET1 WI,TSET2 WI,脂肪抑制GRET1 WI,延迟增强GRET1 WI,磁共振胰胆管造影 (MRCP)和三维动态对比增强MRA(3DDCEMRA)。肿瘤累及胰周血管根据程度依次分为 0～ 4级。结果 :1 8例胰腺癌肿瘤病灶 ,在GRET1 WI上均呈稍低信号 ,TSET2 WI上均呈稍高信号。脂肪抑制GRET1 WI上所有肿瘤均呈明显低信号 ,延迟增强GRET1 WI上肿瘤表现环形不规则强化 1 4例 ,均匀强化 4例 ,但均低于正常胰腺强化。MRCP显示胆总管与主胰管均扩张表现为典型“双管征”8例。在 3DDCEMRA上 ,根据肿瘤与血管周径接触面 >1 / 2为不能切除的标准 ,则门静脉受累 56 % (1 0 / 1 8) ,脾静脉受累 39% (7/ 1 8) ,肠系膜上静脉受累 67%(1 2 / 1 8) ,腹腔干及主要分支受累 2 2 % (4/ 1 8)及肠系膜上动脉受累 1 7% (3/ 1 8)。MRI判断 2例可完全手术切除 ,与手术结果相符。结论 :MRI快速扫描序列、脂肪抑制技术、MRCP及 3DDCEMRA四大MR成像技术的综合应用能提供胰腺癌诊断及手术可切除性判断的必需信息 。Objective:To study multiple MRI techniques in the diagnosis of pancreatic carcinoma and the assessment of its resectability.Methods:MRI was performed in 18 cases with surgically and pathologically proved pancreatic carcinoma.The following sequences were used:GRE T 1WI,TSE T 2WI,GRE T 1WI+fat suppression,delayed enhancement GRE T 1WI,MRCP and MRA in MR scanning.Involvement of tumor to the peripancreatic vessels was prospectively graded into the order of 0～4 based on circumferential contiguity of tumor to vessel.Results:All the lesions showed slight hypointensity on T 1WI,obvious hypointensity on T 1WI with fat suppression,and hyperintensity on T 2WI.On delayed enhancement T 1WI,the lesions displayed irregularly circular enhancement in 14 and homogeneous enhancement in 4,but lower intensity than normal pancreatic tissue enhanced.MRCP showed dilatation of common bile duct and main pancreatic duct as a typical double duct sign in 8.On 3D DCE MRA,it was unresectable on the basis of that with more than half circumferential involvement of tumor to vessel.The portal,splenic and superior mesenteric veins shown were involved with 56%(10/18),39%(7/18),67%(12/18),respectively.And the celiac trunk and its main branches and superior mesenteric arteries were involved with 22%(4/18)and 17%(3/18),respectively.Two cases were able to be resected by assessment of MRI and their resultant resection agreed with the surgical findings.Conclusion:The combined use of the MRI sequences mentioned above can be 'all in one' approach in diagnosis of pancreatic cancer and providing the mandatory information for its resectability.

关 键 词：胰腺癌 诊断 可切除性 磁共振成像 磁共振胰胆管造影 三维动态对比增强MRA MRI快速扫描序列 脂肪抑制技术 

分 类 号：R735.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]