低张水成像联合多模态MRI对十二指肠原发性肿瘤及肿瘤样病变的诊断价值

Hypotonic Hydro-MRI Combined with Multimodal MRI for Diagnosis of Duodenal Primary Tumor and Tumor-Like Lesions

目的探讨低张水成像联合多模态MRI在十二指肠原发性肿瘤及肿瘤样病变中的诊断价值。资料与方法回顾性分析40例十二指肠原发性病变的低张水成像联合多模态MRI征象及病理结果,比较良性组与恶性组间各形态评价参数、表观扩散系数(ADC)值及增强时间-信号强度曲线(TIC)的差异。结果良性组25例,恶性组15例。良性组形态较规则18例(72.0%)、黏膜完整18例(72.0%)、管壁柔软16例(64.0%),恶性组形态不规则10例(66.7%)、黏膜破坏13例(86.7%)、管壁僵硬12例(80.0%),两组3个征象差异均有统计学意义(P<0.001)。恶性组浸润周围组织与发生转移的比例均高于良性组(P<0.001);良性组ADC值>0.7×10^-3 mm^2/s 23例(92.0%),恶性组ADC值≤0.7×10^-3 mm^2/s 10例(66.7%),差异有统计学意义(P<0.001);良性组TIC曲线Ⅰ、Ⅱ型23例(92.0%),恶性组TIC曲线Ⅲ型8例(53.3%),差异有统计学意义(χ^2=11.555,P=0.003)。结论良、恶性十二指肠原发性病变的形态学特征不同,且恶性病变的ADC值比良性低,TIC曲线以Ⅲ型为主。低张水成像MRI较常规扫描更有利于观察病变的形态学特征,联合多模态MRI有助于十二指肠原发性病变的鉴别诊断。

Purpose To investigate the value of hypotonic hydro-MRI combined with multimodal MRI for diagnosing duodenal primary tumor and tumor-like lesions.Materials and Methods Forty patients with primary duodenal lesions were enrolled in this study,the signs of hypotonic hydro-MRI combined with multimodal MRI and the histopathological results were retrospectively analyzed,the morphological evaluation parameters,apparent diffusion coefficient(ADC)and time-signal intensity curve(TIC)between benign group and malignant group were compared.Results For 40 patients,25 were benign lesions and 15 were malignant lesions.In benign lesions,the shape was regular in 18 lesions(72.0%),the mucous membrane was intact in 18 lesions(72.0%),the intestinal wall was soft in 16 lesions(64.0%);in malignant lesions,the shape was irregular in 10 lesions(66.7%),the mucous membrane was damaged in 13 lesions(86.7%),the intestinal wall was stiffness in 12 lesions(80.0%);there were statistically significant differences lesion shape,intestinal wall suppleness and mucosal appearance between benign lesions and malignant lesions(P<0.001).The proportion of infiltrating surrounding tissue and metastasis in the malignant lesions was higher than that in the benign lesions(P<0.001).In benign lesions,the ADC value was above 0.7×10^-3 mm^2/s in 23 lesions(92.0%);and in the malignant lesions,the ADC value was below 0.7×10^-3 mm^2/s in 10 lesions(66.7%),with statistically significant difference(P<0.001).The dynamic contrast-enhanced time-signal intensity curve(TIC)was typeⅠor typeⅡin 23 benign lesions(92.0%),and was typeⅢin 8 malignant lesions(53.3%),with statistical difference(χ^2=11.555,P=0.003).Conclusion The morphological characteristics are different between benign and malignant lesions;the ADC value of malignant lesions is lower than that of the benign lesions,and the TIC is given priority to typeⅢ.Compared with conventional scanning method,the hypotonic hydro-MRI is more beneficial to observe the morphological characteristics of the lesions,and combined with multimodal MRI,it is helpful for the diagnosis and differential diagnosis of primary duodenal lesions.