Erturk Sukru M, Ichikawa Tomoaki, Motosugi Utarou, Sou Hironobu, Araki Tsutomu
Department of Radiology, Sisli Etfal Hospital, Istanbul, Turkey.
Am J Gastroenterol. 2006 Jan;101(1):133-6. doi: 10.1111/j.1572-0241.2006.00406.x.
To evaluate diffusion weighted MR imaging before and after secretin stimulation in the assessment of pancreatic exocrine function in the setting of chronic pancreatitis.
Nine patients with severe chronic pancreatitis and sixteen patients without chronic pancreatitis but with a history of chronic alcohol consumption were enrolled in the chronic pancreatitis and risk groups, respectively. Thirty-eight patients without any pancreatic disease or history of alcohol consumption were included in the control group. Diffusion weighted images were obtained before and after secretin administration in all patients. The peak ADC values and times were determined and intergroup differences were compared. A receiver operating characteristic curve (ROC) was used to identify the cutoff values of the peak ADC times for discrimination of control group from risk and chronic pancreatitis groups.
In the control group, a peak increase in ADC value of 57-120% (median: 75%) was observed between 90 s and 4 min (median: 2 min) after administration of secretin (Pattern 1). In the risk group, in 13 patients, a peak increase of 52-150% was observed between 4 and 8 min (median: 7 min; Pattern 2). Peak times were significantly longer in risk group (p < 0.01). In three patients in the risk group, and in all patients in the chronic pancreatitis group, no ADC peak was observed within 10 min following secretin administration (Pattern 3). Using a peak time of 4 min as the cut-off value, a sensitivity of 100% and specificity of 94.7% were achieved in discriminating the control group from the combined risk and chronic pancreatitis groups.
Diffusion-weighted MR imaging before and after secretin administration could yield clinically useful information for detecting pathophysiologic alterations in the setting of chronic pancreatitis.
评估在慢性胰腺炎背景下，促胰液素刺激前后的扩散加权磁共振成像在胰腺外分泌功能评估中的作用。
分别将9例重症慢性胰腺炎患者和16例无慢性胰腺炎但有慢性饮酒史的患者纳入慢性胰腺炎组和风险组。38例无任何胰腺疾病或饮酒史的患者纳入对照组。对所有患者在注射促胰液素前后进行扩散加权成像。确定ADC峰值和时间，并比较组间差异。采用受试者操作特征曲线（ROC）确定将对照组与风险组和慢性胰腺炎组区分开来的ADC峰值时间的临界值。
在对照组中，注射促胰液素后90秒至4分钟（中位数：2分钟）内，ADC值峰值增加57% - 120%（中位数：75%）（模式1）。在风险组中，13例患者在4至8分钟（中位数：7分钟；模式2）内观察到峰值增加52% - 150%。风险组的峰值时间明显更长（p < 0.01）。风险组中的3例患者以及慢性胰腺炎组中的所有患者在注射促胰液素后10分钟内均未观察到ADC峰值（模式3）。以4分钟的峰值时间作为临界值，在区分对照组与联合风险组和慢性胰腺炎组时，灵敏度达到100%，特异性达到94.7%。
注射促胰液素前后的扩散加权磁共振成像可为检测慢性胰腺炎背景下的病理生理改变提供临床有用信息。
