Wang Dong-qing, Zeng Meng-su, Jin Da-yong, Lou Wen-hui, Ji Yuan, Rao Sheng-xiang, Chen Cai-zhong, Li Ren-chen
Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Zhonghua Zhong Liu Za Zhi. 2007 Mar;29(3):216-20.
To evaluate various kinds of sequences and modified dynamic contrast-enhanced MRI methods in the diagnosis of pancreatic carcinoma.
Forty-nine pancreatic carcinoma patients proved by histopathology or clinical examination and follow-up underwent MR examination. Plain MR sequences included: T1-weighted 2D FLASH, T1 WI 3D VIBE, TSE T2 WI and HASTE with FS. Modified dynamic contrast-enhanced scanning procedures were coronal scaning with 3D FLASH and axial scaning using T1 WI 3D VIBE sequences in turn for the upper abdominal area and pancreatic area. The coronal imaging were used to obtain 3D peripancreatic vessels during arterial phase and portal vein phase scanning, respectively. The axial imaging were used to detect the tumor in pancreatic parenchymal phase and delayed phase scanning, respectively. Final scanning for the whole upper abdomen was performed using T1 WI 2D FLASH axial sequence.
(1) Of 49 lesions in these patients, 45 showed hypo-intensity and 4 iso-intensity on 3D VIBE. Forty-six lesions showed hypo-intensity and 3 isointensity on 2D FLASH. On TSE T2 + FS, lesion contour was not clear enough; 3 of them displayed isointensity, the other showed iso- or hyper-intensity. (2) During pancreatic parenchymal phase, 48 lesions showed hypo-intensity and 39 ring enhancement. Twenty-four lesions displayed marginal tubercle and inner compartment enhancement during portal vein and delayed phase. Six lesions showed iso- or hyper-intensity in delayed phase. (3) Thirty-seven patients underwent surgical exploration. MRI and MRA had a good correlation with surgical findings for peripancreatic vessels which were diagnosed as being invasive or noninvasive by tumors except three superior mesenteric arteries and four superior mesenteric veins being misdiagnosed.
As"one-stop-shop" MRI examination, modified MRI sequences consisting of dynamic coronal and axial contrast-enhanced scanning is feasible and helpful in diagnosing, staging and assessing the resectability for pancreatic carcinoma.
评估各种序列及改良动态对比增强磁共振成像（MRI）方法在胰腺癌诊断中的应用。
49例经组织病理学或临床检查及随访证实的胰腺癌患者接受了MR检查。常规MR序列包括：二维快速低角度激发（2D FLASH）T1加权成像、三维容积内插屏气检查（3D VIBE）T1加权成像、快速自旋回波（TSE）T2加权成像及脂肪抑制快速采集弛豫增强序列（HASTE）。改良动态对比增强扫描程序为：依次采用三维快速低角度激发（3D FLASH）进行冠状位扫描及三维容积内插屏气检查（3D VIBE）T1加权成像序列进行上腹部及胰腺区域的轴位扫描。冠状位成像分别用于在动脉期和门静脉期扫描时获取胰腺周围血管的三维图像。轴位成像分别用于在胰腺实质期和延迟期扫描时检测肿瘤。最后采用二维快速低角度激发（2D FLASH）轴位序列对整个上腹部进行扫描。
（1）在这些患者的49个病灶中，45个在三维容积内插屏气检查（3D VIBE）上表现为低信号，4个表现为等信号。46个病灶在二维快速低角度激发（2D FLASH）上表现为低信号，3个表现为等信号。在快速自旋回波（TSE）T2加权脂肪抑制序列上，病灶轮廓显示不够清晰；其中3个表现为等信号，其余表现为等信号或高信号。（2）在胰腺实质期，48个病灶表现为低信号，39个病灶呈环形强化。24个病灶在门静脉期和延迟期表现为边缘小结节及内部强化。6个病灶在延迟期表现为等信号或高信号。（3）37例患者接受了手术探查。MRI和磁共振血管造影（MRA）对胰腺周围血管的手术所见具有良好的相关性，除3支肠系膜上动脉和4支肠系膜上静脉被误诊外，肿瘤对血管的侵犯与否诊断准确。
作为“一站式”MRI检查，由动态冠状位和轴位对比增强扫描组成的改良MRI序列在胰腺癌的诊断、分期及评估可切除性方面是可行且有帮助的。
