联合应用多种MR成像技术对胰腺癌的诊断价值

Diagnostic value of combination various MR iamging techniqes for pancreatic carcinoma

目的:探讨MRI多种成像技术对胰腺癌的诊断价值,确定胰腺MRI的最佳扫描组合序列。方法:回顾性分析经手术病理证实的43例胰腺癌的MRI图像,扫描序列包括:平扫FS FLASH T1WI、TSE T2WI、True FISP T2WI、HASTE-MRCP和动态增强3D VIBE序列等。测量正常胰腺与病灶的信号强度,计算胰腺/肿瘤的CNR,对各序列图像质量进行评分。将各序列MRI诊断和评价结果与手术病理对照。结果:胰腺/肿瘤CNR:多时相动态增强3D VIBE序列,以胰腺实质期的胰腺/肿瘤的CNR最高(9.7),其同期所获得的图像质量最优(3.54±0.64),均优于平扫各序列(P<0.05)。对胰腺肿瘤的评价:动态增强3D VIBE序列在检出胰腺癌及评价癌肿胰周血管受累、邻近器官受侵及转移灶方面均为最优(P<0.05);MRCP对胰腺癌导致的胰胆管受侵最敏感,其次是True FISP序列;综合各序列诊断的敏感性和准确性均优于任何单一的平扫、水成像或动态增强扫描序列。结论:胰腺癌的MR检查,多种扫描序列各有优缺点,联合应用能发挥最大潜力。理想的检查组合应包括:平扫屏气FS FLASH T1WIT、SE T2WI、高分辨率的厚层及薄层MRCP、屏气的三维梯度回波序列多时相动态增强扫描。

Objective：To evaluate the value of various MR fast pulse sequence in diagnosis of pancreatic carcinoma, and to identify the optimal combination of pulse sequence. Methods：43 patients who were confirmed to have pancreatic carcinoma were underwent MR examination. The MR sequences included： FS FLASH T1WI, TSE T2WI or True-FISP T2WI, HASTE-MRCP and multiphase dynamic enhaneed 3D VIBE. Signal intensifies of normal pancreas and pancreatic carcinoma were measured, for calculating the pancreas/tumor＇ s CNR; and images quality were assessed and various MR imaging results were compared with surgical pathologic findings. Results：Pancreas/tumor＇s CNR： the ldghest CNR was occurred at pancreatic parenchyma-phase of multiphase dynamic enhanced 3D VIBE T1WI （9.7） and the best image quality was also get at the same phase（3.54 ± 0.64）, which had significantly statistical difference vs the other sequences. Evaluation of pancreatic carcinoma： the multiphase dynamic enhanced 3D VIBE T1WI was more sensitive and accurate than the other sequences on detection of tumor, the degree of local tumor extension, per pancreatic vascular involvement, the metastasis. MRCP was more sensitive on evaluating involvement of pancreatic and biliary duct; the next was True FISP.sequence. Diagnosis on combination of multiple sequences was more sensitive and accurate than any sequence alone. Conclusion： Various sequences have their own advantages and limits on MR examination of pancreatic carcinoma. Combined application of various sequences can exert the potential of MRI. The optimal combination of sequences must include unenhanced brcath-hold FS FLASH T1 WI, TSE T2WI, high resolution MRCP of thick and thin slice and multi-phase dynamic enhanced 3D VIBE T1WI .