胰腺神经内分泌肿瘤：T2 加权成像与高 b 值扩散加权成像融合对肿瘤检测的增值作用。

Pancreatic neuroendocrine tumor: added value of fusion of T2-weighted imaging and high b-value diffusion-weighted imaging for tumor detection.

机构信息

Hôpital Erasme - Université Libre de Bruxelles Medical Imaging Department, MRI Division, Route de Lennik 808, 1070 Brussels, Belgium.

出版信息

Eur J Radiol. 2012 May;81(5):e746-9. doi: 10.1016/j.ejrad.2012.01.032. Epub 2012 Mar 3.

DOI:10.1016/j.ejrad.2012.01.032

PMID:22386133

Abstract

OBJECTIVES

To investigate the added value of fusion of high b-value diffusion-weighted images (DWI) and T2-weighted (T2) MR images for the detection of pancreatic neuroendocrine tumors (PNT).

METHODS

18 patients with 18 histologically proven PNT were included. Two radiologists independently and retrospectively reviewed four randomized images sets (T2+T1, DWI, T2+DWI, and DWI+T2 fusion). Lesion detection confidence level was assessed using a three grade score (no lesion; uncertain lesion and certain lesion); lesion size and signal intensity were recorded. Apparent diffusion coefficients (ADC) of tumor and adjacent pancreas were measured.

RESULTS

Readers 1 and 2 respectively detected 14/18 and 16/18 lesions on T2+T1, 13/18 and 12/18 on DWI, 16/18 and 15/18 on T2+DWI and 17/18 and 16/18 on DWI+T2 fusion. Lesion median size was 16 mm (range: 7 mm-40 mm), 22% were hyperfunctioning (all insulinomas) and 72% were low-grade (Rindi 1). All tumors except one (with cystic component) showed lower ADC than adjacent pancreatic parenchyma. Fusion imaging had significantly better detection score by both authors (p<0.005) and provided the higher inter-reader agreement (kappa 0.7). DWI alone had the worst score for both readers.

CONCLUSIONS

Fusion images improve the detection of PNT, especially in patients with small isointense lesions on conventional MR sequences.

摘要

目的

研究高 b 值弥散加权成像（DWI）与 T2 加权（T2）MR 图像融合对胰腺神经内分泌肿瘤（PNT）检测的附加价值。

方法

纳入 18 例经组织学证实的 PNT 患者。两名放射科医生独立回顾性分析了四组随机图像（T2+T1、DWI、T2+DWI 和 DWI+T2 融合）。使用三级评分（无病变、不确定病变和确定病变）评估病变检测置信度；记录病变大小和信号强度。测量肿瘤和相邻胰腺的表观扩散系数（ADC）。

结果

两位读者分别在 T2+T1 上检测到 14/18 和 16/18 个病变，在 DWI 上检测到 13/18 和 12/18 个病变，在 T2+DWI 上检测到 16/18 和 15/18 个病变，在 DWI+T2 融合上检测到 17/18 和 16/18 个病变。病变中位大小为 16mm（范围：7mm-40mm），22%为功能性（均为胰岛素瘤），72%为低级别（Rindi 1 级）。除 1 个（伴囊性成分）外，所有肿瘤的 ADC 均低于相邻胰腺实质。融合成像在两位作者（p<0.005）中均具有更好的检测评分，并提供了更高的读者间一致性（kappa 值为 0.7）。单独的 DWI 对两位读者的评分最差。