Schima Wolfgang, Függer Reinhold, Schober Ewald, Oettl Claudia, Wamser Peter, Grabenwöger Florian, Ryan J Mark, Novacek Gottfried
Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
AJR Am J Roentgenol. 2002 Sep;179(3):717-24. doi: 10.2214/ajr.179.3.1790717.
The purpose of this study was to compare mangafodipir trisodium-enhanced MR imaging performed with a phased array coil and contrast-enhanced single-detector helical CT for accuracy in the detection and local staging of pancreatic adenocarcinoma and in the differentiation between cancer and focal pancreatitis.
Forty-two patients with suspected pancreatic masses underwent contrast-enhanced helical CT and mangafodipir trisodium-enhanced MR imaging at 1.5 T. The images were assessed for the presence or absence of tumors; characterization of masses; and presence of vascular invasion, lymph node metastases, or liver metastases. Imaging findings were correlated with findings at laparotomy, laparoscopy, biopsy, or follow-up.
Focal masses were present in 36 patients (cancer, n = 26; focal pancreatitis, n = 7; other, n = 3). The sensitivity for lesion detection of MR imaging was 100% and of CT, 94%. Two small malignant lesions were missed on CT. For the diagnosis of tumor nonresectability, the sensitivity of MR imaging and CT was 90% and 80%, respectively. Liver metastases were missed on MR imaging in one of the eight patients and on CT in four. For differentiation between adenocarcinoma and nonadenocarcinoma, the sensitivity of MR imaging was 100% (positive predictive value, 90%; negative predictive value, 100%), and the sensitivity of CT was 92% (positive predictive value, 80%; negative predictive value, 67%). Receiver operating characteristic analysis revealed that the mean area under the curve for MR imaging was 0.920 and for CT, 0.832 (not significant).
Mangafodipir trisodium-enhanced MR imaging is as accurate as contrast-enhanced helical CT for the detection and staging of pancreatic cancer but offers improved detection of small pancreatic metastases and of liver metastases compared with CT.
本研究旨在比较使用相控阵线圈进行的锰福地匹三钠增强磁共振成像（MR成像）与对比增强单排螺旋CT在胰腺腺癌检测、局部分期以及癌症与局灶性胰腺炎鉴别诊断方面的准确性。
42例疑似胰腺肿块患者接受了1.5T的对比增强螺旋CT和锰福地匹三钠增强MR成像检查。对图像进行评估，以确定是否存在肿瘤、肿块特征以及是否存在血管侵犯、淋巴结转移或肝转移。影像学检查结果与剖腹手术、腹腔镜检查、活检或随访结果进行对照。
36例患者存在局灶性肿块（癌症26例；局灶性胰腺炎7例；其他3例）。MR成像检测病变的敏感性为100%，CT为94%。CT漏诊了2个小的恶性病变。对于肿瘤不可切除性的诊断，MR成像和CT的敏感性分别为90%和80%。8例患者中有1例的肝转移在MR成像中漏诊，4例在CT中漏诊。对于腺癌与非腺癌的鉴别，MR成像的敏感性为100%（阳性预测值90%；阴性预测值100%），CT的敏感性为92%（阳性预测值80%；阴性预测值67%）。受试者操作特征分析显示，MR成像的曲线下平均面积为0.920，CT为0.832（无显著性差异）。
锰福地匹三钠增强MR成像在胰腺癌检测和分期方面与对比增强螺旋CT一样准确，但与CT相比，对小的胰腺转移灶和肝转移灶的检测能力有所提高。
