Trikudanathan Guru, Walker Sidney P, Munigala Satish, Spilseth Ben, Malli Ahmad, Han Yusheng, Bellin Melena, Chinnakotla Srinath, Dunn Ty, Pruett Timothy L, Beilman Gregory J, Vega Peralta Jose, Arain Mustafa A, Amateau Stuart K, Schwarzenberg Sarah J, Mallery Shawn, Attam Rajeev, Freeman Martin L
Division of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA.
Center for Diagnostic Imaging, Minneapolis, Minnesota, USA.
Am J Gastroenterol. 2015 Nov;110(11):1598-606. doi: 10.1038/ajg.2015.297. Epub 2015 Sep 15.
Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).
Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS ≥6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.
Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS≥2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS≥6). There was a significant correlation between the number of features and severity of fibrosis (r=0.6, P<0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.
A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.
对于表现为慢性腹痛的患者，非钙化性慢性胰腺炎（NCCP）的诊断具有挑战性且存在争议。对比增强磁共振成像（MRI）联合促胰液素刺激磁共振胰胆管造影（sMRCP）为诊断轻度慢性胰腺炎提供了一种安全且无创的方法，但其检查结果尚未与组织病理学进行关联。我们旨在评估一组接受全胰切除联合胰岛自体移植（TPIAT）的NCCP患者中，一系列MRI/sMRCP检查结果与手术组织病理学之间的相关性。
从我们机构的手术数据库中识别出2008年至2013年间因NCCP接受TPIAT的成年患者，如果他们在手术前一年内进行了MRI/sMRCP检查，则纳入研究。在TPIAT时，通过对胰头、胰体和胰尾进行楔形活检，从切除的胰腺获取组织学样本，并由一位对影像学特征不知情的胃肠病理学家进行分级。纤维化评分（FS）为2或更高被视为异常，FS≥6为严重纤维化。在考虑年龄、性别、吸烟、饮酒和体重指数（BMI）后，对预测纤维化的MRI特征进行多因素回归分析。进行定量受试者操作特征（ROC）曲线分析并计算Spearman等级相关系数（r）。
共识别出57例患有NCCP且进行了MRI/sMRCP检查的患者（女性49例，男性8例）。ROC曲线分析表明，两个或更多的MRI/sMRCP特征在区分异常（FS≥2）与正常胰腺组织时，提供了最佳的敏感性（65%）、特异性（89%）和准确性（68%）平衡。两个或更多特征在预测严重纤维化（FS≥6）时提供了最佳截断值（敏感性88%，特异性78%）。特征数量与纤维化严重程度之间存在显著相关性（r = 0.6，P < 0.0001）。在考虑年龄、吸烟和BMI后进行的线性回归分析表明，主胰管不规则、胰腺与椎旁肌之间的T1加权信号强度比以及促胰液素注射后的十二指肠充盈是纤维化的重要独立预测因素。
MRI/sMRCP检查结果与NCCP的组织病理学之间存在强相关性。
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