Tajima Yoshitsugu, Kuroki Tamotsu, Tsutsumi Ryuji, Isomoto Ichiro, Uetani Masataka, Kanematsu Takashi
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
World J Gastroenterol. 2007 Feb 14;13(6):858-65. doi: 10.3748/wjg.v13.i6.858.
To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis.
Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n=33), tumor-forming pancreatitis (n=8), and islet cell tumor (n=7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-I, II, III, and IV, respectively, and were then compared to the corresponding histological pancreatic conditions.
Pancreatic carcinomas demonstrated type-III (n=13) or IV (n=20) TIC. Tumor-forming pancreatitis showed type-II (n=5) or III (n=3) TIC. All islet cell tumors revealed type-I. The type-IV TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.
Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.
评估动态对比增强磁共振成像（MRI）获得的胰腺时间-信号强度曲线（TIC）对胰腺局灶性肿块的鉴别能力，尤其是鉴别与慢性胰腺炎并存的胰腺癌和肿瘤性胰腺炎。
回顾性分析48例接受胰腺局灶性肿块手术的患者，包括胰腺导管癌（n = 33）、肿瘤性胰腺炎（n = 8）和胰岛细胞瘤（n = 7）。其中5例胰腺癌与长期慢性胰腺炎并存。术前从每位患者的胰腺肿块以及肿块病变近端和远端的胰腺实质获取胰腺TIC，并根据达到峰值的时间分为4种类型：分别在注射造影剂团注后25秒以及1、2和3分钟，即分别为I型、II型、III型和IV型，然后将其与相应的胰腺组织学情况进行比较。
胰腺癌表现为III型（n = 13）或IV型（n = 20）TIC。肿瘤性胰腺炎表现为II型（n = 5）或III型（n = 3）TIC。所有胰岛细胞瘤均显示为I型。IV型TIC仅在胰腺癌中出现，并且即使在慢性胰腺炎患者中，癌的TIC在每位患者测量的3种胰腺TIC中达到峰值的上升总是最慢的。
动态MRI的胰腺TIC为区分胰腺癌与其他胰腺肿块提供了可靠信息，并且可能使我们能够避免不必要的胰腺手术以及在胰腺癌正确诊断方面的延误，尤其是在长期慢性胰腺炎患者中。
