Gd-DTPA 3D FSPGR MR动态增强在胰腺癌诊断和术前可切除性评估中的价值

Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging

目的 探讨钆喷酸葡胺三维快速扰相梯度回波(Gd DTPA 3D FSPGR)MR动态增强成像在胰腺癌诊断和术前可切除性评估中的价值。方法 32 例经手术病理证实的胰腺癌,手术前2 周行MRI检查。MRI序列包括脂肪抑制梯度回波T1W(GRE T1W)、快速自旋回波呼吸门控脂肪抑制T2W(FSE RG T2W)、单次激发快速自旋回波T2W(SSFSE T2W)、单次激发自旋快速回波MRI胰胆管成像(MRCP)和Gd DTPA 3D FSPGR MRI动态增强。回顾性分析胰腺癌的MRI征象,根据肿瘤病灶特征、局部侵犯、血管受累和转移情况进行可切除性评估,并与手术结果对照分析。结果 32 例中MRI正确诊断29 例,准确率达90. 6%。肿块检出率: 脂肪抑制GRET1W+FSE RG T2W序列为84.4%(27/32), Gd DTPA 3D FSPGR动态增强成像为93.8%(30/32)。MRI动态增强成像对胰周血管受累、胰周侵犯评价准确性分别为87.0%(20/23)、87.5%(21/24); 对淋巴结、肝脏转移和腹膜癌变诊断准确性分别为80.0%(12/15)、88.9%(8/9)及83.3%(5/6)。3D FSPGR动态增强MRI认为手术可切除8例,实际术中切除7例; 24例认为不可切除,实际手术不可切除23例; 判断胰腺癌可切除的敏感性、特异性及准确性分别为87.5%、95.8%及93.8%。结论 Gd DTPA 3D FSPGR MR动态增强成像提高了胰腺癌的肿瘤病灶及转移灶的检出和定性?

Objective To study the value of Gd-DTPA three dimension fast spoiled gradient-echo (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma. Methods Thirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted(GRE T1W) with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. Results Of 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8 %(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%(21/24), 87.0%(20/23), 80.0%(12/15), 88.9%(8/9) and 83.3%(5/6) respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twenty-three cases were confirmed non-resectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%,95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology (κ= 0.83 ).Conclusion Using of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.