磁共振T_1W/WATS/FFE增强扫描在胰腺癌诊断中的价值

THE DIAGNOSTIC VALUE OF MR T_1W/WATS/FFE ENHANCED SCAN FOR PANCREATIC CARCINOMA

目的:分析磁共振T_1W/WATS/FFE(T_1加权选择性水激励快速梯度回波成像)三期增强扫描在胰腺癌诊断中的价值,并探讨其对胰腺癌定性诊断的敏感度、特异度及准确度。方法:①胰腺癌组:经手术病理或临床随访证实的胰腺癌患者37例(其中胰头癌28例,胰腺颈部癌3例,胰腺体尾部癌6例)。②对照组:健康志愿者32例。两组均采用1.5T磁共振成像仪,行T_1W/WATS/FFE三期增强扫描。计算胰腺癌及正常胰腺各期(动脉期、实质期、门脉期)的强化率。绘制ROC曲线,确定最佳诊断阈值,判断其诊断价值,得出该试验诊断胰腺癌的灵敏度、特异度及准确度。结果:胰腺癌强化呈逐渐上升型,动脉期及实质期轻度强化,门脉期强化率最大;正常胰腺强化呈速升速降型,实质期强化率最大。胰腺癌与正常胰腺的三期强化率间差异均具有统计学意义。实质期最佳阈值(强化率=28.253%)诊断胰腺癌,其灵敏度为94.59%、特异度为93.75%、准确度为94.20%;门脉期则最低。结论:①T_1W/WATS/FFE增强扫描能够反映胰腺癌及正常胰腺的强化方式,测量各期强化率有助于胰腺癌的诊断。②应用T_1W/WATS/FFE增强扫描的三期强化率进行最佳阈值诊断胰腺癌均具有较好诊断价值,以实质期价值最高。

Objective： To analyze the diagnostic value of T1W/WATS/FFE enhanced scan for pancreatic carcinoma, and to explore its sensitivity, specificity and accuracy qualitative in diagnosis of pancreatic carcinoma. Methods： ①Pancreatic carcinoma group： 37 pancreatic carcinoma patients （28 cases in the head, 3 cases in theneck, 6 cases in the body and empennage） were proved by surgery and pathology or clinical follow up. ②Control group： among 32 normal healthy volunteers, two groups underwent T1W/WATS/FFE enhanced scan by 1.5 T MRI. The signal enhancement ratio （SER）with arterial phase, parenchymal phase and portal phase were measured forpancreatic carcinomas and normal pancreas. ROC curves drawn were used to decide the best diagnostic threshold and judge the diagnostic value, and to obtain the sensitivity, sensitivity and accuracy. Results： Pancreatic carcinoma showed slow-up enhancement, arterial phase and parenchymal phase showed slight enhancement; normal pancreas showed fast-up-and-down enhancement, SER of parenchymal phase was maximum, SER ofportal phase was maximum. The differences of SER in three phases between normal pancreas and pancreatic carcinoma were statistically significant. The best diagnostic threshold in parenchymal phase （SER=28.253%） for diagnosing pancreatic carcinoma, its sensitivity , specificity and accuracy were 94.59% ,93.75% and 94.20% respectively. All of them were minimum in portal phase. Conclusions： ①W/WATS/FFE enhanced scan can reflect the enhancement way of pancreatic carcinoma and normal pancreas, the measurement of SER of eachphase contributes to diagnosing pancreatic carcinoma. ②The best diagnostic threshold applied by the SER in TIW/WATS/FFE enhanced scan for diagnosing pancreatic carcinoma has better diagnostic value, the parenchymal phase for diagnosis is the best.