Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Invest Radiol. 2010 Apr;45(4):217-24. doi: 10.1097/RLI.0b013e3181d2eeb1.
To evaluate the diagnostic performance of 1.0-M gadobutrol-enhanced, 3-dimensional (3D), dynamic MR images with 3D-MR cholangiography (MRC) in the preoperative evaluation of bile duct cancer staging and resectability.
Our institutional review board approved this retrospective study. Sixty patients (46 male, 14 female; mean age 65.9 years; range, 45-77 years) with surgically and pathologically proven bile duct cancers, were included in this study. Two gastrointestinal radiologists evaluated the biliary MR images, including 3D-MRC and gadobutrol-enhanced, dynamic images, using a 3D-gradient echo (GRE) technique, regarding the longitudinal tumor extent, vascular involvement of the bile duct cancer, lymph node metastasis, and tumor resectability. The results were compared with the surgical and pathology findings used as the reference standards.
The area under the receiver operating characteristic curve (Az) of the 2 reviewers was 0.95 and 0.93, respectively, for evaluation of the involvement of both secondary biliary confluences and 0.85 and 0.84, respectively, for assessment of the intrapancreatic duct. For determining the tumor resectability, the overall accuracy was 0.93 and 0.88, respectively, whereas for assessment of the vascular involvement, the Az values were 0.92 for reviewer 1 and 0.70 for reviewer 2 for the portal vein evaluation, and 0.99 for reviewer 1 and 0.76 for reviewer 2 for the hepatic artery evaluation. In the assessment of lymph node metastasis, the overall accuracy was approximately 0.77 for each reviewer.
One-molar, gadobutrol-enhanced, dynamic imaging, using a 3D-GRE technique with isotropic 3D-MRC showed excellent diagnostic capability for assessing the longitudinal extent and tumor resectability of bile duct cancer, although it generally underestimated the tumor involvement of vessels and lymph nodes.
评估 1.0-M 钆布醇增强的三维（3D）动态 MR 成像与 3D-MR 胆管成像（MRC）在术前胆管癌分期和可切除性评估中的诊断性能。
本研究经机构审查委员会批准。共纳入 60 例经手术和病理证实的胆管癌患者（男 46 例，女 14 例；平均年龄 65.9 岁；范围，45-77 岁）。两位胃肠放射科医生使用 3D 梯度回波（GRE）技术评估包括 3D-MRC 和钆布醇增强动态成像在内的胆道 MR 图像，评估肿瘤的纵向范围、胆管癌的血管受累情况、淋巴结转移和肿瘤可切除性。结果与手术和病理发现进行比较，作为参考标准。
两位观察者评估二级胆管汇合处受累的受试者工作特征曲线下面积（Az）分别为 0.95 和 0.93，评估胰内胆管受累的 Az 分别为 0.85 和 0.84。对于判断肿瘤可切除性，总的准确性分别为 0.93 和 0.88，而对于评估血管受累情况，门静脉评估的 Az 值分别为观察者 1 的 0.92 和观察者 2 的 0.70，肝动脉评估的 Az 值分别为观察者 1 的 0.99 和观察者 2 的 0.76。在评估淋巴结转移方面，每位观察者的总体准确性约为 0.77。
使用 3D-GRE 技术和各向同性 3D-MRC 的 1.0-M 钆布醇增强动态成像对评估胆管癌的纵向范围和肿瘤可切除性具有优异的诊断能力，尽管它通常低估了肿瘤对血管和淋巴结的累及程度。
