MRI在胰腺炎与胰头癌鉴别诊断中价值

MRI in the differentiation of pancreatic head carcinoma and pancreatitis

目的探讨MRI对胰头部IgG_4相关自身免疫性胰腺炎(autoimmune pancreatitis,AIP)和肿块型胰腺炎(mass-forming chronic pancreatitis,MFCP)及胰头癌的诊断及鉴别诊断价值。方法回顾性分析15例胰头部IgG_4相关AIP患者(AIP组)、10例胰头部MFCP患者(MFCP组)与20例胰头癌患者(胰头癌组)的常规MRI影像学资料,比较患者形态学和表观扩散系数(apparent diffusion coefficient,ADC)值。结果AIP组、MFCP组、胰头癌组T_1加权成像多表现为低信号,T_2加权成像、扩散加权成像多表现为高信号,ADC图上多表现为低信号;胰头癌组病变区及病变周围组织囊肿发生率(10.0%)低于AIP组(20.0%)和MFCP组(50.0%),胰腺周围组织及大血管侵犯发生率(80.0%)、胰腺周围淋巴结肿大发生率(25.0%)及胰、胆管扩张发生率(85.0%)高于AIP组(26.7%、0、26.7%)和MFCP组(20.0%、0、30.0%)(P<0.05),AIP组与MFCP组比较差异均无统计学意义(P>0.05);3组胰头体积增大发生率比较差异无统计学意义(P>0.05);AIP组肿块区ADC值[(1.03±0.10)×10^(-3)mm^2/s]低于MFCP组[(1.32±0.31)×10^(-3)mm^2/s]和胰头癌组[(1.44±0.15)×10^(-3)mm^2/s](P<0.05),MFCP组与胰头癌组比较差异无统计学意义(P>0.05)。结论MRI能从形态学和功能学两方面为鉴别胰头癌和胰头慢性炎症提供依据,具有重要临床意义。

Objective To investigate the value of MRI to the diagnosis and differentiation of IgG4 related autoimmune pancreatitis （AIP） and mass-forming chronic pancreatitis （MECP）. Methods The MRI findings were retrospectively analyzed in 15 patients with IgG4 related AIP at pancreatic head （AIP group）, 10 patients with MFCP （MFCP group）, and 15 patients with pancreatic head carcinoma （pancereatlc head carcinoma group）. The image features and apparent diffusion coefficient （ADC） values were compared. Results AIP, MFCP and pancreatic head carcinoma groups mostly showed hypointensity on Ti weighted image, hyperintensity on Tz weighted image and diffusion weighted imaging, and hypointensity on ADC. The incidence of cyst in tumor or its adjacent tissue was significantly lower in pancreatic head carcinoma group （10. 0%） than that in AIP group （20. 0%） and MFCP group （50. 0%）, while the incidences of infiltration into great vessel or adjacent tissue, lymph node enlargement, and pancreaticobiliary duct dilation were significantly higher in pancreatic head carcinoma group （80.0%, 25.0%, 85.0%） than those in AIP group （26.7%, 0, 26.7%） and MFCP group （20.0%, 0, 30.0%） （P〈0.05）, and there were no significant differences between AlP group and MFCP group （P〉0.05）. There was no significant difference in the incidence of pancreatic head volume enlargement among three groups （P〉0.05）. The ADC was significantly lower in AIP group （（1.03±0.10）×10^-3mm^2/s） than that in MFCP group （（1.32~0.31）×10^-3mm^2/s） and pancreatic head carcinoma group （（1.44±0. 15）×10^-3mm^2/s） （P〈 0.05）, while there was no significant difference between MFCP group and pancreatic head carcinoma group （P〉0.05）. Conclusion MRI has a great clinical significance in the differentiation of chronic pancreatitis and pancreatic head carcinoma on the basis of morphological and functional features.