动态增强MRI评估胰腺导管内乳头状黏液性肿瘤恶性潜能的价值

The value of dynamic contrast-enhanced MRI in evaluating the malignant potential of intraductal papillary mucinous neoplasms

目的:探讨采用动态增强MRI评估胰腺导管内乳头状黏液性肿瘤(IPMNs)恶性潜能的价值。方法:回顾性分析经手术病理证实115例IPMNs患者的动态增强MRI的影像学表现、临床及病理资料。男75例,女40例;年龄41~83岁,平均(63.8±7.9)岁。将患者分为轻度~中度不典型增生组、重度不典型增生组和IPMN伴浸润性癌三组。分析三组IPMNs在DCE-MRI动态增强MRI上的影像学表现,包括病灶位置、壁结节、主胰管管径、胰腺周围组织及血管侵犯情况等。参照2016年修订版福冈共识对IPMNs进行影像学分类。结果:三组间可强化壁结节≥5mm、主胰管≥10mm、主胰管改变伴远端实质萎缩这3个征象出现率的差异有统计学意义(P<0.05)。肿瘤指标CA19-9升高在低度~中度不典型增生与浸润性癌组间差异有统计学意义(P<0.017)。结论:DCE-MRI动态增强MRI对评估IPMNs恶性潜能有一定价值。

Objective:The purpose of this study was to explore the value of dynamic contrast-enhanced MRI(DCE-MRI)for predicting the malignant potential of intraductal papillary mucinous neoplasms(IPMNs).Methods:Imaging,clinical and pathological data of 115 patients with IPMNs were retrospectively analyzed.There were 75 males and 40 females,aged from 41 to 83 years with an average of(63.8±7.9)years.The patients were divided into three groups according to the neoplastic transformation degrees of pancreatic lesion:low-to-moderate grade dysplasia group,high-grade dysplasia group and invasive carcinoma group.The imaging features of IPMNs on DCE-MRI was analyzed,including location of cystic lesion,size of mural nodule,diameter of main pancreatic duct,peripancreatic tissue invasion,vascular invasion and distant metastasis.IPMNs were classified according to the revisions of international consensus Fukuoka guidelines in 2016.Results:Significant differences were found in the four signs among the three groups:enhanced mural nodules(≥5mm),main pancreatic duct(≥10mm),abrupt change of the main pancreatic duct caliber with distal pancreatic atrophy(P<0.05).The elevation of CA19-9 was significantly different between low-to-moderate grade dysplasia and invasive carcinoma group(P<0.017).Conclusion:DCE-MRI has certain value in evaluating the malignant potential of IPMNs.