常规磁共振成像、磁共振胰胆管成像及磁共振弥散加权成像联合鉴别诊断良恶性壶腹周围病变的价值

Value of conventional magnetic resonance imaging,magnetic resonance cholangiopancreatography and magnetic resonance diffusion weighted imaging in the differential diagnosis of benign and malignant periampullary lesions

目的分析常规磁共振成像(MRI)、磁共振胰胆管成像(MRCP)、磁共振弥散加权成像(DWI)序列联合鉴别诊断良恶性壶腹周围病变的价值。方法抽取许昌市中心医院2018年1月至2021年6月收治的壶腹周围病变患者157例,均行MRI、MRCP、DWI诊断,以病理诊断结果为"金标准",比较三者单独和联合诊断的诊断结果、诊断效能,并分析比较恶性和良性病变的影像学特征。结果157例壶腹周围病变患者经病理诊断为恶性72例,良性85例;采用MRI诊断出恶性61例,良性69例;采用MRCP诊断出恶性64例,良性71例;采用DWI诊断出恶性71例,良性81例。MRI、MRCP、DWI联合诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值均高于三者单独诊断,漏诊率、误诊率均低于三者单独诊断(P<0.05);壶腹周围恶性病变患者MRI序列T1加权像呈低、等信号,T2加权像呈等、稍高信号;MRCP序列胆总管远端不规则且不对称;DWI序列弥散受限制(P<0.05)。结论壶腹周围恶性病变的影像学特征与良性病变存在显著差异,常规MRI、MRCP、DWI序列联合诊断可有效鉴别壶腹周围病变性质。

Objective To analyze the application value of routine magnetic resonance imaging(MRI),magnetic resonance cholangiopancreatography(MRCP)and magnetic resonance diffusion weighted imaging(DWI)sequences in the differential diagnosis of benign and malignant periampullary lesions.Methods A total of 157 patients with periampullary lesions treated in Xuchang Central Hospital from January 2018 to June 2021 were diagnosed by MRI,MRCP and DWI.The pathological diagnosis results were taken as the gold standard.The diagnostic results and diagnostic efficacy of the three single diagnostic methods and combination of them were compared,and the imaging characteristics of malignant and benign lesions were analyzed and compared.Results Among the 157 patients with periampullary lesions,72 cases of malignant and 85 cases of benign were diagnosed by pathological diagnosis;61 malignant cases and 69 benign cases were diagnosed by MRI;64 malignant cases and 71 benign cases were diagnosed by MRCP;71 malignant cases and 81 benign cases were diagnosed by DWI.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combination of MRI,MRCP and DWI were higher than those of the three single diagnostic,and the missed diagnosis rate and misdiagnosis rate were lower than those of the three single diagnostic methods(P<0.05).MRI sequence of patients with periampullary malignant lesions showed low and equal signal on T1 weighted image and equal and slightly high signal on T2 weighted image;MRCP showed irregular and asymmetric distal common bile duct,and DWI sequence diffusion was limited(P<0.05).Conclusions There are significant differences between peiampullary malignant lesions and benign lesions.The combination of routine MRI,MRCP and DWI sequences can effectively distinguish the nature of periampullary lesions.