胰腺癌与肿块型慢性胰腺炎的鉴别：高 b 值扩散加权成像的作用。

Differentiation between pancreatic carcinoma and mass-forming chronic pancreatitis: usefulness of high b value diffusion-weighted imaging.

机构信息

Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.

出版信息

J Dig Dis. 2011 Oct;12(5):401-8. doi: 10.1111/j.1751-2980.2011.00517.x.

DOI:10.1111/j.1751-2980.2011.00517.x

PMID:21955434

Abstract

OBJECTIVE

To investigate the value of high b value diffusion-weighted (DW) imaging in differentiating between pancreatic carcinoma and mass-forming chronic pancreatitis (MFCP).

METHODS

Fifty-one consecutive patients with pathology-proven pancreatic carcinoma (n = 37) or MFCP (n = 14) were evaluated with DW imaging (b value, 0 and 1000 s/mm(2)) at a 3-T MR system. Overall 20 healthy volunteers were evaluated as the control group. The apparent diffusion coefficient (ADC) values of normal pancreas, pancreatic carcinoma, MFCP, and mass-associated obstructive pancreatitis were measured.

RESULTS

On high b value (1000 s/mm(2) ) DW images, both pancreatic carcinoma and MFCP were hyperintense focal lesions; mass-associated obstructive pancreatitis occurred in 17 of 37 (45.9%) pancreatic carcinoma and 8 of 14 (57.1%) MFCP. The ADC (×10(-3) mm(2) /s) of the pancreatic carcinomas (1.06 ± 0.15) was significantly lower than that of normal pancreas (1.47 ± 0.18; P < 0.01), MFCP (1.35 ± 0.14; P < 0.01) and mass-associated chronic pancreatitis (1.44 ± 0.17; P < 0.01). The ADC of MFCP was also lower than that in the normal pancreas (P = 0.025), whereas the ADC of mass-associated obstructive pancreatitis was not different from those of the MFCP (P = 0.113) and normal pancreas (P = 0.544). When 1.195 was used as the optimal cut-off value, ADC quantification obtained a sensitivity of 85.7% and a specificity of 86.5% for differentiating pancreatic carcinomas from MFCP.

CONCLUSION

High b value DW imaging in combination with ADC quantification at a 3-T MR system is useful in differentiating between pancreatic carcinoma and MFCP.

摘要

目的

探讨高 b 值扩散加权成像（DW）在鉴别胰腺癌和肿块型慢性胰腺炎（MFCP）中的价值。

方法

在 3.0T MR 系统上对 51 例经病理证实的胰腺癌（n = 37）或 MFCP（n = 14）患者进行 DW 成像（b 值为 0 和 1000 s/mm2）检查。另外，20 例健康志愿者作为对照组。测量正常胰腺、胰腺癌、MFCP 和肿块相关的阻塞性胰腺炎的表观扩散系数（ADC）值。

结果

在高 b 值（1000 s/mm2）DW 图像上，胰腺癌和 MFCP 均为高信号局灶性病变；37 例胰腺癌中有 17 例（45.9%）和 14 例 MFCP 中有 8 例（57.1%）发生肿块相关的阻塞性胰腺炎。胰腺癌的 ADC（×10-3mm2/s）值（1.06 ± 0.15）明显低于正常胰腺（1.47 ± 0.18；P < 0.01）、MFCP（1.35 ± 0.14；P < 0.01）和肿块相关的慢性胰腺炎（1.44 ± 0.17；P < 0.01）。MFCP 的 ADC 值也低于正常胰腺（P = 0.025），而肿块相关的阻塞性胰腺炎的 ADC 值与 MFCP（P = 0.113）和正常胰腺（P = 0.544）之间无差异。当以 1.195 作为最佳截断值时，ADC 定量分析在鉴别胰腺癌和 MFCP 方面的敏感性为 85.7%，特异性为 86.5%。