3.0T磁共振多模态成像在壶腹周围癌诊断及鉴别诊断中的价值
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摘要
目的研究3.0T磁共振多模态成像在壶腹周围癌诊断及鉴别诊断中的价值。方法分析经手术病理证实的57例壶腹周围癌患者的常规MRI、MRCP及DWI影像图像,由两名影像医生对影像图像进行分析,并与病理结果进行对照,分别用方差分析、卡方检验和Fisher精确检验,获得具有诊断这四种肿瘤特征性的影像。结果十二指肠腔内突入性体积较小的肿块合并扩张的胆总管末端呈钝形是十二指肠腺癌特征性的影像表现;胆管腔内较小肿块或胆管壁增厚合并扩张胆管末端呈喙状、突然变细或鼠尾样狭窄是末端胆总管癌特征性的的影像表现,壶腹部胆管壁增厚合并未扩张的胰管、四管征是壶腹癌特征性的影像表现;胰头增大、胆管腔外肿块合并病变以上胆管轻度扩张、较大的腔胆距离及胆胰角、延迟强化、DWI高信号是胰头癌特征性的影像特征。结论 3.0T磁共振多模态成像在壶腹周围癌诊断及鉴别诊断中的具有重要应用价值。
Objective To study the value of 3.0 T multimode MRI in the diagnosis and differential diagnosis of periampullary carcinoma. Methods MRI, MRCP images and DWI of 57 patients with periampullary carcinoma confirmed by surgery and pathology were studied. Images were analysed by two imagers and compared with pathological results to analye the difference of four types of tumors. Analysis of variance, chi-square test and fisher precision test were used to find the characteristic signs in these four kinds of tumors. Results The small mass in the duodenal cavity and the obtuse end of the dilated bile duct were the characteristic signs in duodenal papillary carcinoma. Characteristic images in differentiating terminal choledochal carcinoma were small lump in bile duct, thickening of bile duct wall in bile duct cavity, the beak shape end of the dilated bile duct, and sudden thinning or rat tail stenosis. The wall thickening of the ampullary duct combined with undilated pancreatic duct and four duct sign was an important imaging feature in distinguishing carcinoma of ampulla. The important imaging features of carcinoma of pancreas head were enlarged head of pancreas, slight dilatation of the bile duct above the lesion, the larger distance between the lumen and the biliary, arger angle of the pancreaticobiliary angle and delayed enhancement. Conclusion 3.0 T magnetic resonance multimodality imaging has an important application value in the diagnosis and differential diagnosis of periampullary carcinoma.
Objective To study the value of 3.0 T multimode MRI in the diagnosis and differential diagnosis of periampullary carcinoma. Methods MRI, MRCP images and DWI of 57 patients with periampullary carcinoma confirmed by surgery and pathology were studied. Images were analysed by two imagers and compared with pathological results to analye the difference of four types of tumors. Analysis of variance, chi-square test and fisher precision test were used to find the characteristic signs in these four kinds of tumors. Results The small mass in the duodenal cavity and the obtuse end of the dilated bile duct were the characteristic signs in duodenal papillary carcinoma. Characteristic images in differentiating terminal choledochal carcinoma were small lump in bile duct, thickening of bile duct wall in bile duct cavity, the beak shape end of the dilated bile duct, and sudden thinning or rat tail stenosis. The wall thickening of the ampullary duct combined with undilated pancreatic duct and four duct sign was an important imaging feature in distinguishing carcinoma of ampulla. The important imaging features of carcinoma of pancreas head were enlarged head of pancreas, slight dilatation of the bile duct above the lesion, the larger distance between the lumen and the biliary, arger angle of the pancreaticobiliary angle and delayed enhancement. Conclusion 3.0 T magnetic resonance multimodality imaging has an important application value in the diagnosis and differential diagnosis of periampullary carcinoma.
引文
[1] Yong Eun Chung, Myeong-Jin Kim, Mi-Suk Park. Differential features of pancreatobiliary-and intestinal-type ampullary carcinomas at MR imaging [J]. Radiology, 2010, 257(2): 384-393.
[2] Bin Li, Lei Zhang, Zhui-Yang Zhang. Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography [J]. Eur Radiol, 2015, 25(2): 391-401.
[3] Margareta Heby, Jakob Elebro, Bjrn Nodin. Prognostic and predictive significance of podocalyxin-like protein expression in pancreatic and periampullary adenocarcinoma [J]. BMC Clinical Pathology, 2015, 15: 10.
[4] Kim MJ, Mitchell DG, Ito K, et al. Biliary dilatation: differentiation of benign from malignant causes-value of adding conventional MR imaging to MR cholangiopancreatography [J]. Radiology, 2000, 214(1): 173-81.
[5] Amandeep Singh, Harkaran singh mann, Chuni lal thural. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice [J]. Journal of Clinical and Diagnostic Research, 2014, 8(3): 103-107.
[6] Sugita R, Furuta A, Ito K, et al. Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens [J]. Radiology, 2004, 231(3): 767-774.
[7] Paxton. Dickson, Stephen, Behrman. Distal cholangiocarcinoma [J]. Surg Clin N Am, 2014, 94(2): 325-342.
[8] Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens [J]. Radiology, 2004, 231(3): 767-774.
[9] Soto JA, Alvarez O, Lopera JE, et al. Biliary obstruction:findings at MR cholangiography and crosssectional MR imaging [J]. RadioGraphics, 2000, 20(2): 353-366.
[10] Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [J]. Radiology, 2002, 224(1): 34-41.
[11] Stefano Andrianello, Salvatore Paiella, Valentina Allegrini. Pancreaticoduodenectomy for distal cholangiocarcinoma:surgical results, prognostic factors, and long-term follow-up [J]. Langenbecks Arch Surg, 2015, 400(5): 623-628.
[12] Kim JH, Kim MJ, Chung JJ, et al. Differential diagnosis of periampullary carcinomas at MR imaging [J]. Radio-Graphics, 2002, 22(6): 1335-1352.
[13] Dong Sheng Wu, Wei Xia Chen, Xiao Dong Wang, et al. Pancreaticobiliary duct changes of periampullary carcinomas: quantitative analysis at MR imaging [J]. European Journal of Radiology, 2012, 81(9): 2112-2117.
[14] Jorge Ahualli. The double duct sign [J]. Radiology, 2007, 244(1): 314-315.
[15] Ji Yang Kim, Jeong Min Lee, PhD Joon Koo Han. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures [J]. J Magn Reson Imaging, 2007, 26(2): 304-312.
[2] Bin Li, Lei Zhang, Zhui-Yang Zhang. Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography [J]. Eur Radiol, 2015, 25(2): 391-401.
[3] Margareta Heby, Jakob Elebro, Bjrn Nodin. Prognostic and predictive significance of podocalyxin-like protein expression in pancreatic and periampullary adenocarcinoma [J]. BMC Clinical Pathology, 2015, 15: 10.
[4] Kim MJ, Mitchell DG, Ito K, et al. Biliary dilatation: differentiation of benign from malignant causes-value of adding conventional MR imaging to MR cholangiopancreatography [J]. Radiology, 2000, 214(1): 173-81.
[5] Amandeep Singh, Harkaran singh mann, Chuni lal thural. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice [J]. Journal of Clinical and Diagnostic Research, 2014, 8(3): 103-107.
[6] Sugita R, Furuta A, Ito K, et al. Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens [J]. Radiology, 2004, 231(3): 767-774.
[7] Paxton. Dickson, Stephen, Behrman. Distal cholangiocarcinoma [J]. Surg Clin N Am, 2014, 94(2): 325-342.
[8] Reiji Sugita, Akemi Furuta, Kei Ito, et al. Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens [J]. Radiology, 2004, 231(3): 767-774.
[9] Soto JA, Alvarez O, Lopera JE, et al. Biliary obstruction:findings at MR cholangiography and crosssectional MR imaging [J]. RadioGraphics, 2000, 20(2): 353-366.
[10] Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [J]. Radiology, 2002, 224(1): 34-41.
[11] Stefano Andrianello, Salvatore Paiella, Valentina Allegrini. Pancreaticoduodenectomy for distal cholangiocarcinoma:surgical results, prognostic factors, and long-term follow-up [J]. Langenbecks Arch Surg, 2015, 400(5): 623-628.
[12] Kim JH, Kim MJ, Chung JJ, et al. Differential diagnosis of periampullary carcinomas at MR imaging [J]. Radio-Graphics, 2002, 22(6): 1335-1352.
[13] Dong Sheng Wu, Wei Xia Chen, Xiao Dong Wang, et al. Pancreaticobiliary duct changes of periampullary carcinomas: quantitative analysis at MR imaging [J]. European Journal of Radiology, 2012, 81(9): 2112-2117.
[14] Jorge Ahualli. The double duct sign [J]. Radiology, 2007, 244(1): 314-315.
[15] Ji Yang Kim, Jeong Min Lee, PhD Joon Koo Han. Contrast-enhanced MRI combined with MR cholangiopancreatography for the evaluation of patients with biliary strictures: differentiation of malignant from benign bile duct strictures [J]. J Magn Reson Imaging, 2007, 26(2): 304-312.