3.0T磁共振多期增强扫描对胰腺癌术前诊断及手术可切除性评估中的价值
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摘要
目的探究3.0T磁共振(MRI)多期增强扫描对胰腺癌术前诊断及手术可切除性评估中的价值。方法收集2017年2月-2018年2月经手术病理证实为胰腺癌的41例患者的临床资料,均于术前2周内行3.0TMRI常规平扫及多期增强扫描,回顾性分析患者的MRI征象,并根据病灶情况、局部侵犯、转移、血管受累情况评估手术可切除性。结果 MRI常规平扫中发现31例胰腺肿块,动态增强扫描发现37例胰腺肿块,二者检出率比较差异无统计学意义(χ2=3.101,P>0.05),但与强化正常组织比较更明显,可在一定程度上提高肿块检出率;MRI诊断准确率87.80%,误诊率12.20%;LAVA动态增强MRI评估手术可切除性的敏感度、特异度、准确度为81.82%、93.33%、90.24%,Kappa值=0.752,MRI术前评估结果与手术结果一致性较好。结论对胰腺癌患者术前行3.0T MRI多期增强扫描不仅可提高肿瘤病灶及转移灶的检出率,准确评估胰周侵犯及胰周血管受累情况,还可有效评估手术可切除性,为临床治疗方案的制定提供重要参考。
Objective To explore the value of 3.0 T magnetic resonance imaging(MRI multi-phase enhanced scan in the evaluation of preoperative diagnosis and surgical resectability of pancreatic cancer. Methods The clinical data of 41 patients with pancreatic cancer confirmed by surgical pathology from February 2017 to February 2018 were collected. All patients were given 3.0 T MRI plain scan and multi-phase enhanced scan within 2 weeks before operation. The MRI signs were analyzed retrospectively, and the surgical resectability was evaluated according to the lesion condition, local invasion,metastasis and vascular involvement. Results There were 31 cases of pancreatic masses found by routine MRI scan, and 37 cases of pancreatic masses revealed by dynamic enhanced scan, and there was no significant difference in the detection rate between the two methods(χ2=3.101, P>0.05), but it was obvious higher than that of normal enhanced tissues, and it could improve the detection rate of tumors to a certain extent.The diagnostic accuracy and the misdiagnosis rate of MRI were 87.80% and 12.20%. The sensitivity, specificity and accuracy of LAVA dynamic enhanced MRI in assessment of surgical resectability were 81.82%, 93.33% and 90.24%, and the Kappa value was 0.752,and preoperative assessment of MRI was consistent with the surgical outcomes. Conclusion Preoperative 3.0 T MRI multi-phase enhanced scan for patients with pancreatic cancer can not only increase the detection rate of tumor lesions and metastases, but also accurately assess peripancreatic invasion and peripancreatic vascular involvement, and it can effectively evaluate the surgical resectability, and it provides important references for the establishment of clinical treatment regimens.
Objective To explore the value of 3.0 T magnetic resonance imaging(MRI multi-phase enhanced scan in the evaluation of preoperative diagnosis and surgical resectability of pancreatic cancer. Methods The clinical data of 41 patients with pancreatic cancer confirmed by surgical pathology from February 2017 to February 2018 were collected. All patients were given 3.0 T MRI plain scan and multi-phase enhanced scan within 2 weeks before operation. The MRI signs were analyzed retrospectively, and the surgical resectability was evaluated according to the lesion condition, local invasion,metastasis and vascular involvement. Results There were 31 cases of pancreatic masses found by routine MRI scan, and 37 cases of pancreatic masses revealed by dynamic enhanced scan, and there was no significant difference in the detection rate between the two methods(χ2=3.101, P>0.05), but it was obvious higher than that of normal enhanced tissues, and it could improve the detection rate of tumors to a certain extent.The diagnostic accuracy and the misdiagnosis rate of MRI were 87.80% and 12.20%. The sensitivity, specificity and accuracy of LAVA dynamic enhanced MRI in assessment of surgical resectability were 81.82%, 93.33% and 90.24%, and the Kappa value was 0.752,and preoperative assessment of MRI was consistent with the surgical outcomes. Conclusion Preoperative 3.0 T MRI multi-phase enhanced scan for patients with pancreatic cancer can not only increase the detection rate of tumor lesions and metastases, but also accurately assess peripancreatic invasion and peripancreatic vascular involvement, and it can effectively evaluate the surgical resectability, and it provides important references for the establishment of clinical treatment regimens.
引文
[1]杨尹默.胰腺癌外科治疗的热点与难点[J].中华消化外科杂志,2015,14(8):612-614.
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[5]江正卫,曾艳,徐云霞,等.3.0TMRI多期增强扫描术前评估胰腺癌可切除性[J].实用放射学杂志,2017,33(1):66-68.
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[7]Li J,Denniston K A,Hussain S M,et al.Comparison of CT and MRI-Based Gross Tumor Volume and Organ at Risk Delineation for Pancreatic Cancer Patients Undergoing Neoadjuvant Stereotactic Body Radiation Therapy-[J].International Journal of Radiation Oncology Biology Physics,2014,90(1):S356-S356.
[8]陈璐,余日胜.胰腺癌的影像学诊断及术前可切除性和分期的影像学评估[J].临床肝胆病杂志,2016,32(12):2305-2311.
[9]Mori H.Early-stage pancreatic cancer[J].Chinese Journal of Cancer Research,2015,27(4):332-348.
[10]潘晶晶,潘春树,叶慧义.胰腺癌手术可切除性的术前CT及MRI评估[J].肿瘤学杂志,2015,21(10):799-803.
[11]Li J,Denniston K A,Hussain S M,et al.Comparison of CT and MRI-Based Gross Tumor Volume and Organ at Risk Delineation for Pancreatic Cancer Patients Undergoing Neoadjuvant Stereotactic Body Radiation Therapy-[J].International Journal of Radiation Oncology Biology Physics,2014,90(1):S356-S356.
[12]李明山,孟凡琴.受胰腺癌侵犯的胰周血管可切除性的影像学界点选择[J].中国临床医学影像杂志,2015,26(11):798-800.
[13]杨尹默.胰腺癌外科治疗理念更新与技术进步[J].中华消化外科杂志,2017,16(1):34-37.
[2]张丽娟.多层螺旋CT扫描与CT灌注成像在胰腺癌成像中诊断价值及差异[J].中国CT和MRI杂志,2017,15(6):83-86.
[3]陈威,曾燕.多层螺旋CT对胰腺癌周围血管侵犯及肿瘤可切除性的术前评估[J].放射学实践,2018,33(2):177-181.
[4]闫爽.超声联合多层螺旋CT诊断胰腺癌的临床价值[J].中国CT和MRI杂志,2017,15(4):100-102.
[5]江正卫,曾艳,徐云霞,等.3.0TMRI多期增强扫描术前评估胰腺癌可切除性[J].实用放射学杂志,2017,33(1):66-68.
[6]Cuneo K C,Chenevert T L,Ben-Josef E,et al.A Pilot Study of DiffusionWeighted MRI in Patients Undergoing Neoadjuvant Chemoradiation for Pancreatic Cancer[J].Translational Oncology,2014,7(5):644-649.
[7]Li J,Denniston K A,Hussain S M,et al.Comparison of CT and MRI-Based Gross Tumor Volume and Organ at Risk Delineation for Pancreatic Cancer Patients Undergoing Neoadjuvant Stereotactic Body Radiation Therapy-[J].International Journal of Radiation Oncology Biology Physics,2014,90(1):S356-S356.
[8]陈璐,余日胜.胰腺癌的影像学诊断及术前可切除性和分期的影像学评估[J].临床肝胆病杂志,2016,32(12):2305-2311.
[9]Mori H.Early-stage pancreatic cancer[J].Chinese Journal of Cancer Research,2015,27(4):332-348.
[10]潘晶晶,潘春树,叶慧义.胰腺癌手术可切除性的术前CT及MRI评估[J].肿瘤学杂志,2015,21(10):799-803.
[11]Li J,Denniston K A,Hussain S M,et al.Comparison of CT and MRI-Based Gross Tumor Volume and Organ at Risk Delineation for Pancreatic Cancer Patients Undergoing Neoadjuvant Stereotactic Body Radiation Therapy-[J].International Journal of Radiation Oncology Biology Physics,2014,90(1):S356-S356.
[12]李明山,孟凡琴.受胰腺癌侵犯的胰周血管可切除性的影像学界点选择[J].中国临床医学影像杂志,2015,26(11):798-800.
[13]杨尹默.胰腺癌外科治疗理念更新与技术进步[J].中华消化外科杂志,2017,16(1):34-37.