增强磁共振成像与胆胰管成像对胰腺导管内乳头状黏液性肿瘤良恶性鉴别的比较

Comparison of Enhanced Magnetic Resonance Imaging and Magnetic Resonance Cholangiopancreatography in the Differential Diagnosis of Benign and Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas

目的比较肝脏容积加速采集增强磁共振成像(LAVA)扫描和磁共振胆胰管成像(MRCP)对胰腺导管内乳头状黏液性肿瘤(IPMN)的良恶性鉴别诊断价值。方法回顾性分析了经病理证实的35例胰腺IPMN患者的磁共振(MR)资料,所用序列包括T1WI、T2WI、LAVA增强MRI和MRCP。将所有患者的MR资料分成增强MRI组(诊断方法包括T1 WI、T2 WI和增强MRI)和MRCP组(诊断方法包括T1 WI、T2 WI和MRCP)进行比较,采用受试者工作特征曲线(ROC)分析两组诊断方法对IPMN良恶性鉴别诊断的价值。结果共确诊胰腺导管内乳头状黏液瘤23例和黏液癌12例,增强MRI组鉴别诊断的准确度为82.9%(29/35),高于MRCP组的71.4%(25/35),但两者差异无统计学意义(P=0.068)。增强MRI组诊断方法的敏感性、特异性、阳性预测值和ROC曲线下面积(AUC)分别为83.3%、82.6%、71.4%和0.850,MRCP组分别为75.0%、69.6%、52.3%和0.723,其中,增强MRI组诊断方法的AUC明显高于MRCP组(P=0.0465)。结论增强MRI在鉴别诊断IPMN良恶性时较MRCP价值更大。

Objective To compare the value of liver acquisition with volume acceleration （LAVA） and magnetic resonance cholangiopancreatography （MRCP） in diagnosing benign and malignant intraductal pa- pillary mucinous neoplasms （IPMN） of the pancreas. Methods The MR findings of 35 IPMN patients confirmed by pathology were analyzed retrospectively, and the sequences included TIWI, T2WI, LAVA, and MRCP. All patients were divided into two groups： the group of MRI enhancement （including T1WI, T2WI, and MRI enhancement） and the group of MRCP （including T1WI, T2WI, and MRCP）. Two groups were evaluated by the receiver operating characteristic （ROC） curve. Results Totally 23 cases of intraductal papillary mucinous tumors and 12 cases of intraductal papillary mucinous carcinomas were diagnosed. Finally, 29 cases （29/35） of IPMN were diagnosed correctly in the group of MR enhancement, and 25 cases （25/35） diagnosed correctly in the group of MRCP. The differential diagnostic accuracy of the group of MRI enhancement （82. 9% ） was higher than that of the group of MRCP （71.4%）, although the difference was not statistically significant （P =0. 068）. The sensitivity, specificity, positive predictive value, and the area under the ROC curve （AUC） of the group of MRI enhancement were 83.3%, 82. 6%, 71.4%, and 0. 850, and those of the group of MRCP were 75.0%, 69.6%, 52. 3%, and O. 723. The AUC of the group of MRI enhancement was significantly larger than that of the group of MRCP （P = 0. 0465 ）. Conclusion MRI enhancement is more valuable than MRCP in the differential diagnosis of benign and malignant IPMN.