壶腹部浸润性腺癌的MRI诊断与临床应用
|
摘要
目的探讨壶腹部浸润性腺癌(invasive adenocarcinoma of the ampullary region,IAAR)的MRI影像学特征及其临床应用价值。方法回顾性分析22例经病理证实的IAAR患者的MRI检查资料。22例患者均行MRI平扫,其中19例行DWI扫描,19例行MRCP扫描,17例行MR增强扫描。观察病灶的大小、形态、边界、生长方式、内部结构、信号、强化模式及胆总管、主胰管改变等。结果 1)T1WI均表现为等或稍低信号,T2WI 10例呈等信号,12例呈等高信号,DWI18例呈稍高、高信号;增强扫描呈持续性轻度强化。20例伴胆总管扩张、11例伴主胰管扩张;10例侵犯胰腺,5例发生肝转移,8例伴周围淋巴结肿大;2)MRI平扫结合DWI、MRCP、LAVA扫描的定位、定性准确率分别为94.7%(18/19)、89.5%(17/19)、94.1%(16/17)。平扫、DWI、MRCP和LAVA多序列联合诊断IAAR准确率为95.5%(21/22)。结论MRI利用其超高组织分辨率、多角度成像及MRCP、DWI、LAVA等多序列联合检查,能较全面、准确地显示Vater壶腹部细节结构,对IAAR的诊断具有重要价值。
Objective To investigate the magnetic resonance imaging( MRI) features of invasive adenocarcinoma of the ampullary region( IAAR) and its clinical application. Methods MRI of 22 patients with IAAR proved by pathology were analyzed retrospectively. 22 patients underwent plain MRI,of whom 19 underwent DWI scan,19 underwent MRCP scan,and 17 underwent dynamically enhanced MR scan. Observation indictors included tumor size,shape,growth pattern,boundary,internal structure,signal,style of contrast enhancement,changes of bile and/or pancreatic duct. Results 1) All tumors showed slightly lower or equal signal on T1 WI and 10 cases showed equal signal,12 cases showed equal and high signal on T2 WI. 18 cases showed high signal on DWI. Enhancement pattern appeared slightly enhancement. 20 cases presented with common bile duct dilation and 11 cases with main pancreatic duct dilation,pancreas invaded was shown within 10 cases and hepatic metastasis was shown within 5 cases,8 cases showed Peripheral lymphadenectasis; 2) MRI plain scan combined with DWI,MRCP and LAVA sequences,showed the positioning diagnosis and qualitative diagnosis accuracy rate of 94. 7%( 18/19),89. 5%( 17/19),94. 1%( 16/17),respectively. MRI plain scan combined with DWI,MRCP and LAVA sequences,showed the diagnosis accuracy rate of IAAR of 95. 5%( 21/22). Conclusion MRI using higher tissue resolution,multi angle imaging and multi sequences like DWI,MRCP,LAVA,could commendably reveal the details of the ampullary region. MRI has significant value to the diagnosis of IAAR.
Objective To investigate the magnetic resonance imaging( MRI) features of invasive adenocarcinoma of the ampullary region( IAAR) and its clinical application. Methods MRI of 22 patients with IAAR proved by pathology were analyzed retrospectively. 22 patients underwent plain MRI,of whom 19 underwent DWI scan,19 underwent MRCP scan,and 17 underwent dynamically enhanced MR scan. Observation indictors included tumor size,shape,growth pattern,boundary,internal structure,signal,style of contrast enhancement,changes of bile and/or pancreatic duct. Results 1) All tumors showed slightly lower or equal signal on T1 WI and 10 cases showed equal signal,12 cases showed equal and high signal on T2 WI. 18 cases showed high signal on DWI. Enhancement pattern appeared slightly enhancement. 20 cases presented with common bile duct dilation and 11 cases with main pancreatic duct dilation,pancreas invaded was shown within 10 cases and hepatic metastasis was shown within 5 cases,8 cases showed Peripheral lymphadenectasis; 2) MRI plain scan combined with DWI,MRCP and LAVA sequences,showed the positioning diagnosis and qualitative diagnosis accuracy rate of 94. 7%( 18/19),89. 5%( 17/19),94. 1%( 16/17),respectively. MRI plain scan combined with DWI,MRCP and LAVA sequences,showed the diagnosis accuracy rate of IAAR of 95. 5%( 21/22). Conclusion MRI using higher tissue resolution,multi angle imaging and multi sequences like DWI,MRCP,LAVA,could commendably reveal the details of the ampullary region. MRI has significant value to the diagnosis of IAAR.
引文
[1]Adsay V,Ohike N,Tajiri T,et al.Ampullary region carcinomas:definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases[J].Am J of Surg Pathol,2012,36(11):1592-1608.
[2]Casadei R,Zanini N,Morselli-Labate AM,et al.Prognostic factors in periampullary and pancreatic tumor resection in elderly patients[J].World J Surg,2006,30(11):1992-2001.
[3]Showalter TN,Zhan T,Anne PR,et al.The influence of prognostic factors and adjuvant chemoradiation on survival after pancreaticoduodenectomy for ampullary carcinoma[J].J Gastrointest Surg,2011,15(8):1411-1416.
[4]Jang KM,Kim SH,Lee SJ,et al.Added value of diffusionweighted MR imaging in the diagnosis of ampullary carcinoma[J].Radiology,2013,266(2):491-501.
[5]Chung YE,Kim MJ,Park MS,et al.Differential features of pancreatobiliary-and intestinal-type ampullary carcinomas at MR imaging[J].Radiology,2010,257(2):384-393.
[6]Kang SP,Saif MW.Ampullary and periampullary tumors:translational efforts to meet a challenge in diagnosis and treatment.Highlights from the"2011 ASCO Gastrointestinal Cancers Symposium".San Francisco,CA,USA[J].January,2011,12(2):123-125.
[7]Hernandez-Jover D,Pernas JC,Gonzalez-Ceballos S,et al.Pancreatoduodenal junction:review of anatomy and pathologic conditions[J].J of Gastrointest Surg,2011,15(7):1269-1281.
[8]文雪,吴伟强,滕晓东.Vater壶腹部腺鳞癌五例的临床病理分析[J].中华消化杂志,2014,34(5):342-343.
[9]Bernstein C1,Nfonsam V,Prasad AR,et al.Epigenetic field defects in progression to cancer[J].World J Gastrointest Oncol,2013,5(3):43-49.
[10]方三高,马强,曾英,等.壶腹部浸润性腺癌83例临床病理分析[J].诊断病理学杂志,2015,22(2):65-69.
[11]余水莲,马隆佰,刘颖.MRI在原发性十二指肠恶性肿瘤诊断中的应用价值[J].实用放射学杂志,2015,31(2):251-254.
[12]张国慧,王文红,薛继蔚.MRCP联合常规MRI及超声诊断壶腹周围癌的价值[J].实用放射学杂志,2013,29(1):64-67,76.
[13]Lee M,Kim MJ,Park MS,et al.Using multi-detector-row CT to diagnose ampullary adenoma or adenocarcinoma in situ[J].Eur J Radiol,2011,80(3):340-345.
[14]巩涛,王宁,袁淑绘,等,DWI联合MRCP在鉴别诊断壶腹周围病变良恶性中的价值[J].医学影像学杂志,2014,24(5):767-771.
[15]张婷,郑荣琴,许尔蛟,等.双重对比超声造影与增强磁共振成像检出壶腹周围病变的效果比较[J].中华肝脏外科手术学电子杂志,2014,3(3):165-169.
[2]Casadei R,Zanini N,Morselli-Labate AM,et al.Prognostic factors in periampullary and pancreatic tumor resection in elderly patients[J].World J Surg,2006,30(11):1992-2001.
[3]Showalter TN,Zhan T,Anne PR,et al.The influence of prognostic factors and adjuvant chemoradiation on survival after pancreaticoduodenectomy for ampullary carcinoma[J].J Gastrointest Surg,2011,15(8):1411-1416.
[4]Jang KM,Kim SH,Lee SJ,et al.Added value of diffusionweighted MR imaging in the diagnosis of ampullary carcinoma[J].Radiology,2013,266(2):491-501.
[5]Chung YE,Kim MJ,Park MS,et al.Differential features of pancreatobiliary-and intestinal-type ampullary carcinomas at MR imaging[J].Radiology,2010,257(2):384-393.
[6]Kang SP,Saif MW.Ampullary and periampullary tumors:translational efforts to meet a challenge in diagnosis and treatment.Highlights from the"2011 ASCO Gastrointestinal Cancers Symposium".San Francisco,CA,USA[J].January,2011,12(2):123-125.
[7]Hernandez-Jover D,Pernas JC,Gonzalez-Ceballos S,et al.Pancreatoduodenal junction:review of anatomy and pathologic conditions[J].J of Gastrointest Surg,2011,15(7):1269-1281.
[8]文雪,吴伟强,滕晓东.Vater壶腹部腺鳞癌五例的临床病理分析[J].中华消化杂志,2014,34(5):342-343.
[9]Bernstein C1,Nfonsam V,Prasad AR,et al.Epigenetic field defects in progression to cancer[J].World J Gastrointest Oncol,2013,5(3):43-49.
[10]方三高,马强,曾英,等.壶腹部浸润性腺癌83例临床病理分析[J].诊断病理学杂志,2015,22(2):65-69.
[11]余水莲,马隆佰,刘颖.MRI在原发性十二指肠恶性肿瘤诊断中的应用价值[J].实用放射学杂志,2015,31(2):251-254.
[12]张国慧,王文红,薛继蔚.MRCP联合常规MRI及超声诊断壶腹周围癌的价值[J].实用放射学杂志,2013,29(1):64-67,76.
[13]Lee M,Kim MJ,Park MS,et al.Using multi-detector-row CT to diagnose ampullary adenoma or adenocarcinoma in situ[J].Eur J Radiol,2011,80(3):340-345.
[14]巩涛,王宁,袁淑绘,等,DWI联合MRCP在鉴别诊断壶腹周围病变良恶性中的价值[J].医学影像学杂志,2014,24(5):767-771.
[15]张婷,郑荣琴,许尔蛟,等.双重对比超声造影与增强磁共振成像检出壶腹周围病变的效果比较[J].中华肝脏外科手术学电子杂志,2014,3(3):165-169.