MRI三维容积式插入法屏气检查对胰腺癌的诊断价值及对可切除性的评估价值

Value of MRI three-dimensional volumetric interpolated breath-hold examination in the diagnosis and resectability assessment of pancreatic cancer

目的探讨MRI三维容积式插入法屏气检查(3D-VIBE)对胰腺癌的诊断价值及对可切除性的评估价值。方法选取120例胰腺癌患者,均进行自旋回波-回波平面成像(SE-EPI)与3D-VIBE序列MRI检查。以手术后的病理检查结果作为金标准,分析SE-EPI与3D-VIBE序列诊断胰腺癌T分期与术后病理T分期的一致性。采用受试者工作特征曲线(ROC)分析SE-EPI与3D-VIBE序列对胰腺癌的诊断价值。比较胰腺癌患者SE-EPI和3D-VIBE序列扫描的强化特征。以手术实际切除为标准,分析SE-EPI与3D-VIBE序列对胰腺癌可切除性的评估价值。结果SE-EPI与3D-VIBE序列诊断胰腺癌T分期与术后病理T分期的一致性均较好(Kappa=0.875、0.850,P﹤0.01)。ROC曲线显示,3D-VIBE序列诊断胰腺癌的灵敏度和曲线下面积(AUC)均高于SE-EPI序列。3D-VIBE序列的动脉早期信噪比(SNR)、动脉晚期SNR、动脉早期对比度噪声(CNR)、动脉晚期CNR均明显高于SE-EPI序列,差异均有统计学意义(P﹤0.01)。SE-EPI与3D-VIBE序列评估胰腺癌可切除性与手术实际切除的一致性均较好(Kappa=0.967、0.992,P﹤0.01)。结论MRI 3D-VIBE序列对胰腺癌及其T分期具有较高的诊断价值,且对其可切除性具有较高的评估价值。

Objective To evaluate the value of MRI three-dimensional volumetric interpolated breath-hold examination(3D-VIBE)in the diagnosis and resectability assessment of pancreatic cancer.Method A total of 120 patients with pancreatic cancer were selected and all patients were received spin echo-echo planar imaging(SE-EPI)and 3D-VIBE sequence MRI examination.Using the pathological examination results after surgery as the gold standard,the consistency of SE-EPI and 3D-VIBE sequences in diagnosis of pancreatic cancer T stage and postoperative pathological T stage were analyzed.The diagnostic value of SE-EPI and 3D-VIBE sequences in pancreatic cancer were analyzed by receiver operating characteristic(ROC)curve.The enhancement features of SE-EPI and 3D-VIBE sequences scanning in pancreatic cancer were compared.The value of SE-EPI and 3D-VIBE sequences in assessing resectability of pancreatic cancer were analyzed based on actual surgical resection.Result The results of SE-EPI and 3D-VIBE sequences for the diagnosis of pancreatic cancer T stage showed good consistency with postoperative pathological T stage(Kappa=0.875,0.850,P<0.01).ROC curve showed that the sensitivity and area under the curve(AUC)of 3D-VIBE sequence in the diagnosis of pancreatic cancer were higher than those of SE-EPI sequence.The early arterial signal-to-noise ratio(SNR),late arterial SNR,early arterial contrast-to-noise ratio(CNR)and late arterial CNR of 3D-VIBE sequence were significantly higher than those of SE-EPI sequence,and the differences were statistically significant(P<0.01).The results of SE-EPI and 3D-VIBE sequences for the resectability assessment of pancreatic cancer showed good consistency with actual surgical resection(Kappa=0.967,0.992,P<0.01).Conclusion MRI 3D-VIBE sequence has high diagnostic value for pancreatic cancer and its T stage,and has high evaluative value for its resectability.