胰腺MR检查序列应用探讨

Discussion on Application of MRI Sequences on Pancreas

目的分析97例胰腺MRI检查中不同序列图像,探讨胰腺MR扫描序列优化方案。方法胰腺检查患者97例,其中,正常36例、囊肿2例、胰腺炎42例、胰腺肿瘤17例。平扫序列横轴位T2WIFSE、T2WI FS-FSE、T1WI SPGR In phase和Out of phase,T1WI FS-SPGR;冠状位FIESTA,T1WISPGR,动态增强检查序列为LAVA。重点分析胰腺疾病征象在各序列中的显示情况。结果胰腺病变总显示率96.7%,其信号改变以T1WI FS-SPGR显示最优(91.8%);胰周、肾前筋膜改变T2WIFS-FSE序列显示率分别为70.5%、62.3%,二者均具有显著性优势P<0.05;FIESTA对胰管及胰周改变显示率与T2WI FS-FSE相比没有显著性优势P>0.05;MRCP胰管显示率100%,LAVA对各项观察指标显示率并不优于所有平扫序列,对肿瘤病变显示率为94.1%,高于胰腺炎显示率52.4%,但没有统计学意义(P>0.05)。结论 T1WI FS-SPGR序列,可作为胰腺MR平扫的基本序列,T2WI首选T2WI FS-FSE序列,二者结合能很好显示胰腺及周围病变,配合冠状位T1WI SPGR和3D MRCP,显示胰周脂肪结构及胰管情况,部分病变能初步定性,如怀疑胰腺肿瘤,LAVA序列必不可少,可确定病变范围及周围血管、腹膜后受累情况。

Objective Analysis of MRI （Magnetic Resonance Imaging） pictures of various sequences in 97 cases of pancreas in order to explore the optimal MR sequences of pancreatic scanning. Methods There are 36 patients of normal pancreas, 2 patients with pancreatic cyst, 42 with diagnosed pancreatitis and 17 patients with pancreatic neoplasm among 97 cases. The horizontal axis of MRI sequences includes T2WI FSE, T2WI FS-FSE, T^WI SPGR In phase and Out of phase, T^WI FS-SPGR; FIESTA and T^WI SPGR are in the coronary locations; LAVA is the dynamicaUy-enhanced MR/sequence. Analysis of how symptoms of pancreatic diseases are shown in various sequences is made. Results The total display rate of pancreatic lesions is 96.7% with the optimum display of pancreatic signal changes in TlWl FS-SPGR （91.8%）. The display rates of peripancreatic changes and kidney fascia changes in T2W/FS-FSE are 70.5% and 62.3% respectively with significant superiority（P〈0.05）. There were no significant superiority among FIESTA and T2WI FS-FSE in displaying pancreatic duct and peripancreatic region（ P〉0.05）. The display rate of pancreatic duct was 100~,6 on MRCP （Magnetic Resonance Cholangiopanereatngraphy）. Each observation index of LAVA is not superior to all sequence. The display rate of pancreatic neoplam~ of LAVA is 94.1%, superior to pancreatitis（52.4%） with no statistical significance（P〉0.05）. Conclusion T1WI FS-SPGR sequence can be used as basic sequence for pancreatic MR; T2WI FS-FSE is the best choice for T2WI. Combination of T1WI FS-SPGR and T2WI FS-FSE results in excellent display of pancreatic and peripancreatic lesions. With T^WI SPGR and 3D MRCP, peripancreatic fat and pancreatic duct can be well displayed, which provides great help in preliminary diagnosis of some lesions. For patients who are suspected of pancreatic neoplasms, LAVA is of great necessity to be applied so as to diagnose the extent of lesions, status of stmonnding vessel and retroperitoneal space.