应用促胰液素增强磁共振胰胆管成像定量评估慢性胰腺炎的胰腺外分泌功能。
Quantification of pancreatic exocrine function of chronic pancreatitis with secretin-enhanced MRCP.
机构信息
Yun Bian, Li Wang, Chao Chen, Jian-Ping Lu, Jia-Bao Fan, Shi-Yue Chen, Bing-Hui Zhao, Department of Radiology, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China.
出版信息
World J Gastroenterol. 2013 Nov 7;19(41):7177-82. doi: 10.3748/wjg.v19.i41.7177.
AIM
To obtain reference values for pancreatic flow output rate (PFR) and peak time (PT) in healthy volunteers and chronic pancreatitis (CP); to correlate quantification of secretin enhanced magnetic resonance cholangiopancreatography (SMRCP) of pancreatic fluid output following secretin with fecal elastase-1 (FE-1) tests.
METHODS
The present study includes 53 subjects comprised of 17 healthy individuals and 36 patients with CP from April 2011 to January 2013. The 36 patients with CP were divided into three groups of mild CP (n = 14), moderate CP (n = 19) and advanced CP (n = 3) by M-ANNHEIM classification for CP.. Fifty-three cases underwent FE-1 test and magnetic resonance imaging using 3.0 T-device (Signa EXCITE, GE Healthcare). Coronal T2-weighted single-shot turbo spin-echo, spiratory triggered, covering the papillae, duodenum and small bowel. MRCP was performed with a heavily T2-weighted fat-suppressed long TE HASTE sequence (thick slab 2D MRCP sequence), repeated every 2 min up to 11 min after 0.1 mL/kg secretin injection (Secrelux, Sanochemia(®), Germany). FE-1 test used sandwich enzyme-linked immunosorbent assay (ELISA) test (ScheBo. Tech(®), Germany).
RESULTS
A good linear correlation showed between the calculated volume and the actual volume by Phantom experiments. Fifty-three paired Quantification of secretin enhanced magnetic resonance cholangiopancreatography (MRCPQ) and FE-1 data sets were analyzed. The mean FE-1 of 53 cases was 525.41 ± 94.44 μg/g for 17 healthy volunteers, 464.95 ± 136.13 μg/g for mild CP, 301.55 ± 181.55 μg/g for moderate CP, 229.30 ± 146.60 μg/g for advanced CP. Also, there was statistically significant difference in FE-1 (P = 0.0001) between health and CP. The mean values of PFR and PT were 8.18 ± 1.11 mL/min, 5.76 ± 1.71 min for normal; 7.27 ± 2.04 mL/min, 7.71 ± 2.55 min for mild CP; 4.98 ± 2.57 mL/min, 9.10 ± 3.00 min for moderate CP; 4.13 ± 1.83 mL/min, 12.33 ± 1.55 min for advanced CP. Further, statistically significant difference in PFR (P = 0.0001) and PT (P = 0.0001) was observed between health and CP. Besides, there was correlation (r = 0.79) and consistency (K = 0.6) between MRCPQ and ELISA Test. It was related between M-ANNHEIM classification and PFR (r = 0.55), FE-1 (r = 0.57).
CONCLUSION
SMRCP can provide a safe, non-invasive and efficient method to evaluate the exocrine function of the pancreas.
目的
获得健康志愿者和慢性胰腺炎（CP）中胰腺流量输出率（PFR）和峰值时间（PT）的参考值；将促胰液素增强磁共振胰胆管成像（SMRCP）定量检测的胰腺液体分泌与粪便弹性蛋白酶-1（FE-1）检测结果进行相关性分析。
方法
本研究纳入了 2011 年 4 月至 2013 年 1 月的 53 名受试者，包括 17 名健康个体和 36 名 CP 患者。根据 M-ANNHEIM 分类，36 名 CP 患者分为轻度 CP（n=14）、中度 CP（n=19）和晚期 CP（n=3）三组。53 例患者接受了 FE-1 检测和使用 3.0 T 设备（Signa EXCITE，GE Healthcare）进行的磁共振成像检查。冠状 T2 加权单次激发涡轮自旋回波，呼吸触发，覆盖乳头、十二指肠和小肠。MRCP 采用重 T2 加权脂肪抑制长 TE HASTE 序列（厚板 2D MRCP 序列）进行，在 0.1 mL/kg 促胰液素注射后每隔 2 分钟重复一次，直至 11 分钟（Secrelux，Sanochemia（®），德国）。FE-1 检测采用夹心酶联免疫吸附测定（ELISA）检测（ScheBo. Tech（®），德国）。
结果
通过对 Phantom 实验的计算体积和实际体积进行线性相关分析，显示出良好的线性相关性。分析了 53 对促胰液素增强磁共振胰胆管成像（MRCPQ）和 FE-1 数据。健康志愿者 17 名，平均 FE-1 为 525.41±94.44 μg/g；轻度 CP 患者 14 名，平均 FE-1 为 464.95±136.13 μg/g；中度 CP 患者 19 名，平均 FE-1 为 301.55±181.55 μg/g；晚期 CP 患者 3 名，平均 FE-1 为 229.30±146.60 μg/g。健康志愿者和 CP 患者的 FE-1 水平差异具有统计学意义（P=0.0001）。正常组 PFR 和 PT 的平均值分别为 8.18±1.11 mL/min 和 5.76±1.71 min；轻度 CP 组分别为 7.27±2.04 mL/min 和 7.71±2.55 min；中度 CP 组分别为 4.98±2.57 mL/min 和 9.10±3.00 min；晚期 CP 组分别为 4.13±1.83 mL/min 和 12.33±1.55 min。健康志愿者和 CP 患者的 PFR（P=0.0001）和 PT（P=0.0001）水平差异具有统计学意义。此外，MRCPQ 和 ELISA 检测之间存在相关性（r=0.79）和一致性（K=0.6）。M-ANNHEIM 分类与 PFR（r=0.55）和 FE-1（r=0.57）之间存在相关性。
结论
SMRCP 可以提供一种安全、非侵入性和有效的方法来评估胰腺的外分泌功能。
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