DCE-MRI药代动力学参数评估患癌胰腺不同区域功能状态的价值研究

The Value of DCE-MRI Pharmacokinetic Parameters in Evaluating the Functional Status of Different Regions of Pancreatic Cancer

目的:比较胰腺癌(pancreatic cancer,pCa)患者癌灶区、近端胰腺区、远端炎性区及正常胰腺的动态对比增强磁共振成像(dynamic contrast-enhanced MRI,DCE-MRI)药代动力学参数K^(trans)和k(ep),无创量化患癌胰腺不同区域微血管功能状态,评估pCa近端胰腺组织是否为相对正常的胰腺组织。方法:收集病理及临床证实的pCa患者29例腿机选取正常志愿者30例。所有受试者行胰腺DCE-MRI扫描并计算每个观测区的K^(trans)和k(ep)。根据患癌胰腺不同区域状态的差异将其分为pCa组、癌灶近端胰腺组、癌灶远端炎症组,30例正常志愿者胰腺为正常对照组。采用One-way ANOVA分别比较不同组别间K^(trans)s、k(ep)的差异。结果源腺癌、近端胰腺区、远端炎症区及正常胰腺的K^(trans)和k(ep)分别是0.114±0.023、0.066±0.009、0.323±0.026、0.061±0.005和0.341±0.077、0.105±0.017、0.772±0.068、0.107±0.005。pCa的K^(trans)和k(ep)高于近端胰腺区和正常胰腺,而低于远端炎症区,远端炎症区的K^(trans)和k(ep)高于pCa、近端胰腺区和正常胰腺,以上P均<0.001;而近端胰腺和正常胰腺的K^(trans)和k(ep)均无统计学差异(P=0.298、0.893)。结论患癌胰腺不同区域微血管功能状态有明显差异同时提示pCa近端≥1 cm的区域为相对正常的胰腺区,以上可为pCa精准治疗、手术切缘选择提供参考。

Objective:To compare dynamic contrast-enhanced MRI(DCE-MRI)pharmacokinetic parameters Ktrans,kep of normal pancreas and the tumor region,proximal pancreatic region,distal inflammatory region in patients with pancreatic cancer,and to non-invasively quantify the functional status of different regions of the pancreas with cancer.To evaluate whether the proximal pancreatic tissue adjacent to pCa is normal.Methods:29 histologically and clinically proven patients with pancreatic cancer and 30 normal volunteers underwent DCE-MRI.DCE-MRI pharmacokinetic parameters(Ktransand kep)for each observation region were calculated.Pancreases with cancer were divided into pancreatic cancer,proximal pancreas and distal inflammation groups.Pancreases of 30 normal volunteers were as normal control group.One-way ANOVA test were used to evaluate the differences of Ktrans and kep among different groups.Results:Ktrans and kep in pancreatic cancer,proximal pancreatic region,distal inflammatory region and normal pancreas were 0.114±0.023,0.066±0.009,0.323±0.026,0.061±0.005 and 0.341±0.077,0.05±0.017,0.772±0.068 and 0.107±0.005,respectively.The Ktransand kep of pCa were higher than that of proximal pancreas region and normal pancreas,and lower than that of distal inflammatory region(P all<0.001).However there were no significant differences of Ktrans and kep between proximal pancreas region and normal pancreas(P=0.298,0.893).Conclusion:There are differences of microcirculation function for different regions of pancreases with cancer.Proximal pancreas region away from tumor≥1 cm is relatively normal pancreas.These provide references for precise treatment and surgical margin selection of pancreatic cancer.