磁共振DWI与3D-VIBE序列对胰腺癌T分期和可切除性术前预评估的价值

Value of preoperative pre-assessment of MRI-DWI and 3D-VIBE sequence in T-staging and resectability of pancreatic cancer

目的探讨磁共振(MRI)扩散加权成像(DWI)与三维梯度回波容积内插法(3D-VIBE)序列在术前预评估胰腺癌T分期和可切除性中的价值。方法采用随机抽样与回顾性研究法,选取2013年1月至2017年7月接受治疗的40例胰腺癌患者作为研究对象,所有患者都给予MRI DWI与3D-VIBE序列扫描。以术后病理为标准,评价MRI DWI与3D-VIBE术前T分期的诊断效能及在胰腺癌手术可切除性上的术前评估效能(包括敏感性、特异性、准确性);MRI DWI与3D-VIBE在胰腺癌T分期术前预评估和术后病理诊断的一致性分析采用Kappa检验。结果 MRI术前T分期与术后病理T分期有较好的一致性(κ=0.782),MRI术前T分期总的诊断准确率为95.0%。常规MRI直接征象:T_IWI呈低信号21例,病灶边缘强化不规则,强化程度不等;胰腺癌病灶的DWI表观弥散系数(ADC)值和瘤周组织的ADC值比较,差异有统计学意义[(1.56±0.24)×10^(-3) mm^2/s vs(1.91±0.26)×10^(-3) mm^2/s,t=8.284,P<0.01]。以病理结果为标准,MRI评价胰腺癌可切除性的敏感性、特异性、准确性分别为100.0%、75.0%和95.0%。结论 MRI-DWI与3D-VIBE序列诊断胰腺癌可提供较为真实的细微解剖结构特点及异常变化,有助于指导胰腺癌的术前T分期诊断与手术切除治疗的选择。

Objective To investigate the value of preoperative pre-assessment of magnetic resonance imaging(MRI)-diffusion weighted imaging(DWI)and three-dimensional volume interpolated breath-hold examination(3D-VIBE)sequence in T-staging and resectability of pancreatic cancer.Methods Using random sampling and retrospective study methods,40 patients with pancreatic cancer treated from January 2013 to July 2017 were selected as research objects.Routine MRI DWI and 3D-VIBE were performed in all patients.Taking the postoperative pathology as the standard,the diagnostic efficiency pre-operative T-staging of MRI and the preoperative evaluation efficiency for resectability of pancreatic cancer operation(sensitivity,specificity and accuracy)were evaluated.The consistency between preoperative pre-assessment of MRI DWI and 3D-VIBE T-staging of pancreatic cancer and postoperative pathological diagnosis was analyzed by Kappa test.Results The preoperative T-staging of MRI was in good agreement with pathological T-staging(κ=0.782).The overall diagnostic accuracy of preoperative T-staging of MRI was 95.0%.The direct signs of routine MRI showed that T1WI was low signal and irregular enhancement of lesion border with varying degrees in 21 cases.In DWI,there was significant difference in apparent diffusion coefficient(ADC)of cancer lesion and peritumoral tissues[(1.56±0.24)×10-3 mm2/s vs(1.91±0.26)×10-3 mm2/s,t=8.284,P<0.01].Taking the pathological results as the standard,the sensitivity,specificity and accuracy in evaluating the resectability of pancreatic cancer for MRI were 100.0%,75.0%and 95.0%,respectively.Conclusion MRI-DWI and 3D-VIBE can provide more real micro-anatomical features and abnormal changes for the diagnosis of pancreatic cancer and can help to guide preoperative T-staging diagnosis and the choice of surgical resection treatment.