3.0 T质子磁共振波谱在鉴别诊断胰腺癌和胰腺炎中的初步应用

Preliminary application of 3.0 T proton MR Spectroscopy in differential diagnosis of pancreatic cancer and pancreatitis

目的观察急性水肿型胰腺炎、慢性胰腺炎及胰腺癌的质子磁共振波谱(1H-MRS)表现,分析其代谢物峰差异。方法在3.0T磁共振设备上应用单体素点分辨波谱(PRESS)序列,采集15例急性水肿型胰腺炎、10例慢性胰腺炎和20例胰腺癌病人的胰腺1H-MRS。分析波谱中代谢物的表现,比较胰腺炎和胰腺癌的代谢物峰显示率,计算每组胆固醇和不饱和脂肪酸的混合峰(Chol+Unsat)与脂肪峰(Lip)峰高的比值(Chol+Unsat/Lip),并对三组比值行单因素方差分析和组间两两比较。结果胰腺1H-MRS的主要代谢物峰有Lip峰,Chol+Unsat峰和胆碱峰(Cho)。胰腺炎组与胰腺癌组之间Cho峰的显示率差异无统计学意义(χ2=0.104,P=0.748)。急性水肿型胰腺炎、慢性胰腺炎和胰腺癌组Chol+Unsat/Lip比值的均数分别为0.179±0.056、0.274±0.099和0.325±0.187,且三组均数的差异有统计学意义(F=5.011,P=0.011)。其中,急性水肿型胰腺炎与慢性胰腺炎及胰腺癌间Chol+Unsat/Lip比值比较,其差异有统计学意义(P均<0.05),而慢性胰腺炎与胰腺癌之间该比值的差异无统计学意义(P=0.712)。结论 3.0T胰腺1H-MRS中Chol+Unsat/Lip比值升高可能对鉴别急性胰腺炎与慢性胰腺炎及胰腺癌有一定参考价值。

Objective To observe 1H-MRS-appearance of acute pancreatitis, chronic pancreatitis and pancreatic cancer, and to analyze the changes in metabolites. Methods Pancreas spectroscopies of 45 subjects were acquired by single-voxel PRESS sequence on 3.0 T MR scanner. The subjects were divided into three groups, i.e., acute edematous pancreatitis （n=15）, chronic pancreas （n=10）, and pancreatic cancer （n=20）. Visibilities of metabolite were compared between pancreatitis and pancreatic cancer group. The ratio of cholesterol and the olefinic region of fatty acids （Chol＋ Unsat） peak height to lipid （Lip） peak height （Chol＋Unsat/Lip） was calculated in each group. One-way ANOVA with post hoe comparisons was performed among the three groups. Results There were three major resonance peaks in the spectra, Lip, Chol±Unsat, and choline. There was no significant difference in the visible rate of choline （χ2=0.104, P= 0.748） between pancreatitis and pancreatic cancer group. The mean value of Chol＋Unsat/Lip was 0.179±0.056 for acute pancreatitis, 0.274±0.099 for chronic pancreatitis, 0.325 ±0.187 for pancreatic cancer, and they were statistically different among the three groups （F=5.011, P=0.Oll）. Furthermore, statistically significant difference in Chol＋Unsat/Lip was observed between acute panereatitis group and chronic pancreatitis group or pancreatic cancer group （both P〈0.05）, but not between chronic pancreatitis and pancreatic cancer group （P=0.712）. Conclusion Chol＋Unsat/Lip may be helpful in differentiating acute paneeatitis from chronic pancreatitis and pancreatic cancer.