CT和MRI在鉴别非弥漫性自身免疫性胰腺炎与胰腺导管腺癌的价值比较

Comparison of the diagnostic value between CT and MRI in distinguishing nondiffuse-type autoimmune pancreatitis and pancreatic ductal adenocarcinoma

目的比较CT和MRI在鉴别非弥漫性自身免疫性胰腺炎(autoimmune pancreatitis,AIP)与胰腺导管腺癌(pancreatic ductal adenocarcinoma,PDA)的价值。方法选取2015年1月至2018年12月在海南省中医院就诊并经临床确诊的非弥漫性AIP患者共78例,纳入AIP组;另选取同期在我院就诊并经临床确诊的PDA患者共28例,纳入PDA组。采用受试者工作特征曲线比较CT和MRI在鉴别AIP和PDA的表现情况,计算不同影像学方法的敏感度。比较两组患者影像学特征的表现情况。结果MRI鉴别AIP和PDA的曲线下面积显著大于CT(P<0.05)。MRI用于诊断PDA的灵敏度显著高于CT(P<0.05),但MRI和CT对诊断AIP的灵敏度差异无统计学意义(P>0.05)。AIP组中,CT和MRI发现的影像学特征比较,多发胰腺占位、延迟均匀增强、胰管梗阻、多发胰管梗阻的发现率差异有统计学意义(P<0.05)。而在PDA组中,非连续性胰腺占位、胰管梗阻的发现率差异有统计学意义(P<0.05)。结论MRI比CT在鉴别非弥漫性AIP与PDA时的诊断表现更好,MRI能够更多反映出有利于两种疾病鉴别的影像学特征。

Objective To compare the diagnostic value between CT and MRI in distinguishing non-diffuse-type autoimmune pancreatitis(AIP)and pancreatic ductal adenocarcinoma(PDA).Methods A total of 78 patients with AIP in the Hainan Provincial Hospital of Traditional Chinese Medicine from Jan.2015 to Dec.2018 were involved into AIP group;meanwhile,another 28 patients with PDA were assigned into PDA group.CT and MRI were performed in all patients.The diagnostic performance between CT and MRI was compared by receiver operation characteristics analysis and the sensitivity was calculated.Moreover,the key imaging characteristics were compared between CT and MRI.Results The area under curve(AUC)of MRI in differentiating AIP and PDA was significantly bigger than CT(P<0.05).The sensitivity of MRI was also significantly higher than CT in diagnosing PDA(P<0.05),but there was no significant difference in the sensitivity between CT and MRI in diagnosing AIP(P>0.05).To compare the key imaging characteristics in AIP group,the discovery rates of multiple pancreatic mass,delayed homogenous enhancement of the mass pancreatic duct obstruction,and multiple main pancreatic duct obstruction were significantly different between CT and MRI(P<0.05).However,in PDA group,there was significant difference in the ratios of discrete pancreatic mass and pancreatic duct obstruction between CT and MRI(P<0.05).Conclusion MRI has better performance in distinguishing AIP and PDA,and more key imaging characteristics to differentiate two diseases are observed by MRI.