胰胆系肿瘤手术切除可能性的MRI前瞻性研究

Prospective Study on Resectability of Pancreato-biliary Tumors with MRI Examination

目的 :探讨MR多种成像技术对胰胆系肿瘤的诊断与手术切除性评价的临床应用价值。材料和方法 :对17例临床疑为胰胆系肿瘤患者进行前瞻性的诊断和手术切除性研究。手术发现与病理结果证实为胰腺癌11例 ,胆管癌4例 ,非胰胆系肿瘤病变2例。MR多种成像技术包括MR断面成像、MR胰胆管造影(MRCP)和三维动态增强MR门脉造影(3DDCEMRP)。结果 :MR多种成像技术正确诊断17例中的15例(88.2 %)胰胆系肿瘤病变 ,肿瘤累及范围的判断准确性为64.4 %。MR多种成像技术评价胰胆系肿瘤可切除性的敏感性、特异性、准确性以及阳性和阴性预测值分别为83.3 % ,77.8 % ,80.0 % ,71.4 %和87.5 %。与CT比较 ,两者对胰胆系肿瘤的术前评价结果相符性好(κ=0.4737)。结论 :无创伤性的一次性全套MR多种成像技术是胰胆系肿瘤术前诊断。

To evaluate the clinical value of MR multi-imaging technique in diagnosing and assessing the resectability of pancreato-biliary tumors.Materials and Method:The resectability and diagnosis were prospectively evaluated in 17 patients with suspicious pancreato-biliary tumors.Surgical finding and pathologic results confirmed pancreatic adenocarcinomas in 11 cases,cholangiocarcinomas in 4 cases and non-neoplastic lesions in 2 cases. MR multi-imaging protocol included MR cross-sectional imaging,MR cholangiopancreatography(MRCP) and three-dimensional dynamic contrast-enhanced MR portography (3D DCE MRP).Results:MR multi-imaging technique allowed correct diagnosing 15 of 17(88.2%) patients with pancreato-biliary tumors.The accuracy in detecting the range of tumor invasion was 64.4%.The sensitivity,specificity,accuracy,positive and negative predictive value of MR multi-imaging technique in assessing the resectability between pancreato-biliary tumors were 83.3%,77.8%,80.0%,71.4% and 87.5%,respectively.The agreement between CT and MR multi-imaging technique in the assessment of the resectability of pancreato-biliary tumor was good(κ=0.4737).Conclusion:The diagnosis,staging and pre-operative assessment of pancreato-biliary tumor may be more simplified and efficient by using the non-invasive 'all-in-one' method.