磁共振IDEAL-IQ技术在急性胰腺炎诊疗中的应用
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摘要
目的:探讨磁共振定量非对称回波的最小二乘估算法迭代水脂分离序列(IDEAL-IQ)技术在急性胰腺炎诊断及治疗中的应用价值。方法:搜集2016年10月-2018年12月急性胰腺炎患者及正常对照组各40例,其中急性胰腺炎治疗前为A组,有效治疗1周后为B组,正常对照组为C组;分别行MRI T_1WI、T_2WI、IDEAL-IQ成像,分别在脂肪分数图和R_2~*弛豫率图对胰腺头、体、尾部兴趣区脂肪分数值(FF)和R_2~*值,比较各组对象FF、R_2~*值差异;分析急性胰腺炎治疗前后FF、R_2~*差值与血清胰淀粉酶(P-Amy)、脂肪酶(Lps)浓度差之间的相关性。结果:A组(9.84±1.62)、B组(6.51±1.49)、C组(4.93±1.16)FF值(%)差异有统计学意义(P<0.001);A组(26.26±4.86)、B组(19.05±6.65)、C组(13.47±6.43)R_2~*值(Hz)差异有统计学意义(P<0.001)。相关分析显示△FF_(A-B)、△R_(2A*-B)与△P-AmyA-B和△LpsA-B均呈中度正相关(P<0.001)。结论:IDEAL-IQ是一种可重复性好、结果可靠的非侵入性胰腺脂肪定量方法,可对急性胰腺炎患者胰腺内的脂肪含量、铁含量进行定量分析,对急性胰腺炎的诊断及治疗具有重要的指导价值。
Objective:To investigate the value of IDEAL-IQ sequence in quantitative assessment of steatosis and iron deposition in pancreas with acute pancreatitis(AP).Methods:40 AP patients and40 healthy control subjects were performed a MR scan with both IDEAL-IQ sequence and routing T1 W,T2 W.Fat fraction(FF)and R_2~* values were obtained for each part of the pancreas of each group by measuring on fat and R_2~* maps.The differences of FF and R_2~* values among control group,pre-treatment and post-treatment(1 week)of AP group were compared;and the correlation between the mean differences of FF(△FF_(A-B)),R_2~* values(△R_(2 A*-B))and the mean differences of pancreatic amylase(△P-Amy_(A-B))and lipase(△Lps_(A-B))before and after treatment were analyzed respectively.Results:There were significant differences in FF(control 4.93±1.16,Pre-treatment 9.84±1.62,Post-treatment 6.51±1.49)and R_2~* value(control 13.47±6.43,Significant statistic differences were found among three groups(all P<0.05).And the mean values were as follows:FF(%)values of group A(9.84±1.62),group B(6.51±1.49),and group C(4.93±1.16),R_2~* (Hz)values of group A(26.26±4.86),group B(19.05±6.65),and group C(13.47±6.43).△FFA-Band△R2 A*-Bwere positively correlated with△P-AmyA-Band△Lps_(A-B),respectively(all P<0.001).Conclusion:Pancreas may have fat and iron deposition in AP.IDEAL-IQ sequence can be used to quantitatively assess steatosis and iron overload in pancreas parenchyma.△FF_(A-B) and△R_(2 A*-B) may have potential values to predict the efficacy of AP treatment.
Objective:To investigate the value of IDEAL-IQ sequence in quantitative assessment of steatosis and iron deposition in pancreas with acute pancreatitis(AP).Methods:40 AP patients and40 healthy control subjects were performed a MR scan with both IDEAL-IQ sequence and routing T1 W,T2 W.Fat fraction(FF)and R_2~* values were obtained for each part of the pancreas of each group by measuring on fat and R_2~* maps.The differences of FF and R_2~* values among control group,pre-treatment and post-treatment(1 week)of AP group were compared;and the correlation between the mean differences of FF(△FF_(A-B)),R_2~* values(△R_(2 A*-B))and the mean differences of pancreatic amylase(△P-Amy_(A-B))and lipase(△Lps_(A-B))before and after treatment were analyzed respectively.Results:There were significant differences in FF(control 4.93±1.16,Pre-treatment 9.84±1.62,Post-treatment 6.51±1.49)and R_2~* value(control 13.47±6.43,Significant statistic differences were found among three groups(all P<0.05).And the mean values were as follows:FF(%)values of group A(9.84±1.62),group B(6.51±1.49),and group C(4.93±1.16),R_2~* (Hz)values of group A(26.26±4.86),group B(19.05±6.65),and group C(13.47±6.43).△FFA-Band△R2 A*-Bwere positively correlated with△P-AmyA-Band△Lps_(A-B),respectively(all P<0.001).Conclusion:Pancreas may have fat and iron deposition in AP.IDEAL-IQ sequence can be used to quantitatively assess steatosis and iron overload in pancreas parenchyma.△FF_(A-B) and△R_(2 A*-B) may have potential values to predict the efficacy of AP treatment.
引文
[1]侯斐,刘瑞霞,阴赪宏.急性胰腺炎微循环障碍的发生机制及其治疗进展[J].临床肝胆病杂志,2014,30(8):815-818.
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[8]Manfredi R,Bonatti M,D'Onofrio M,et al.Incidentally discovered benign pancreatic cystic neoplasms not communicating with the ductal system:MR/MRCP imaging appearance and evolution[J].Radiol Med,2013,118(2):163-180.
[9]黄梦月,程敬亮,吕晓婷,等.IDEAL-IQ与MRS定量测量肝脏脂肪含量的可行性及相关性[J].放射学实践,2017,32(5):447-450.
[10]Gaeta M,Scribano E,Mileto A,et al.Muscle fat fraction in neuromuscular disorders:dual-echo dual-flip-angle spoiled gradientrecalled MR imaging technique for quantification---afeasibility study[J].Radiology,2011,259(2):487-494.
[11]Ge M,Zhang J,Wu B,et al.Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2*correction and estimation[J].Eur Radiol,2016,26(6):1913-1920.
[12]胡磊,查云飞,林苑,等.IDEAL-IQ定量评价兔糖尿病模型椎体骨髓脂肪含量的可行性研究[J].磁共振成像,2015,6(12):941-946.
[13]林苑,査云飞.MR定量分析异位脂肪沉积的研究进展[J].中华放射学杂志,2017,51(5):397-400.
[14]刘梦苓,黄小华,徐红霞,等.磁共振IDEAL-IQ序列对急性胰腺炎状态下胰腺脂肪沉积和铁沉积的评估[J].放射学实践,2018,33(12):1266-1271.
[15]张钦和,刘爱连,郭维亚,等.IDEAL-IQ评估健康人BMI与胰腺脂肪定量相关性研究[J].中国临床医学影像杂志,2018,29(7):486-490.
[16]Idilman IS,Tuzun A,Savas B,et al.Quantification of liver,pancreas,kidney,and vertebral body MRI-PDFF in non-alcoholic fatty liver disease[J].Abdom Imaging,2015,40(6):1512-1519.
[17]Mathur A,Sandrasegaran K,Zyromski NJ,et al.Fatty pancreasa risk factor for the development of SOD pancreatitis[J].Gastrointest Endosc,2008,67(9):328-333.
[18]Whitcomb DC,Muddana V,Langmead CJ,et al.Angiopoietin-2is a regulator of vascular permeability in inflammation and is associated with persistent organ failure in patients with acute pancreatitis in the United States and Germany[J].American J Gastroenterology,2010,105(10):2287-2292.
[2]Yadav D,Lowenfels AB.The epidemiology of pancreatitis and pancreatic cancer[J].Gastroenterology,2013,144(8):1252-1261.
[3]Sakai NS,Taylor SA,Chouhan MD,et al.Obesity,metabolic disease and the pancreas-Quantitative imaging of pancreatic fat[J].Br J Radiol,2018,91(1089):20180267.
[4]Yoon JH,Lee JM,Lee KB,et al.Pancreatic steatosis and fibrosis:quantitative assessment with preoperative multiparametric MRimaging[J].Radiology,2016,279(1):140-150.
[5]Livingstone RS,Begovatz P,Kahl S,et al.Initial clinical application of modified Dixon with flexible echo times:hepatic and pancreatic fat assessments in comparison with 1 H-MRS[J].MAG-MA,2014,27(5):397-405.
[6]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(5):102-111.
[7]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(2):4-7.
[8]Manfredi R,Bonatti M,D'Onofrio M,et al.Incidentally discovered benign pancreatic cystic neoplasms not communicating with the ductal system:MR/MRCP imaging appearance and evolution[J].Radiol Med,2013,118(2):163-180.
[9]黄梦月,程敬亮,吕晓婷,等.IDEAL-IQ与MRS定量测量肝脏脂肪含量的可行性及相关性[J].放射学实践,2017,32(5):447-450.
[10]Gaeta M,Scribano E,Mileto A,et al.Muscle fat fraction in neuromuscular disorders:dual-echo dual-flip-angle spoiled gradientrecalled MR imaging technique for quantification---afeasibility study[J].Radiology,2011,259(2):487-494.
[11]Ge M,Zhang J,Wu B,et al.Effect of gadolinium on hepatic fat quantification using multi-echo reconstruction technique with T2*correction and estimation[J].Eur Radiol,2016,26(6):1913-1920.
[12]胡磊,查云飞,林苑,等.IDEAL-IQ定量评价兔糖尿病模型椎体骨髓脂肪含量的可行性研究[J].磁共振成像,2015,6(12):941-946.
[13]林苑,査云飞.MR定量分析异位脂肪沉积的研究进展[J].中华放射学杂志,2017,51(5):397-400.
[14]刘梦苓,黄小华,徐红霞,等.磁共振IDEAL-IQ序列对急性胰腺炎状态下胰腺脂肪沉积和铁沉积的评估[J].放射学实践,2018,33(12):1266-1271.
[15]张钦和,刘爱连,郭维亚,等.IDEAL-IQ评估健康人BMI与胰腺脂肪定量相关性研究[J].中国临床医学影像杂志,2018,29(7):486-490.
[16]Idilman IS,Tuzun A,Savas B,et al.Quantification of liver,pancreas,kidney,and vertebral body MRI-PDFF in non-alcoholic fatty liver disease[J].Abdom Imaging,2015,40(6):1512-1519.
[17]Mathur A,Sandrasegaran K,Zyromski NJ,et al.Fatty pancreasa risk factor for the development of SOD pancreatitis[J].Gastrointest Endosc,2008,67(9):328-333.
[18]Whitcomb DC,Muddana V,Langmead CJ,et al.Angiopoietin-2is a regulator of vascular permeability in inflammation and is associated with persistent organ failure in patients with acute pancreatitis in the United States and Germany[J].American J Gastroenterology,2010,105(10):2287-2292.