Yasokawa Kazuya, Ito Katsuyoshi, Kanki Akihiko, Yamamoto Akira, Torigoe Teruyuki, Sato Tomohiro, Tamada Tsutomu
Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan.
Magn Reson Imaging. 2018 May;48:70-73. doi: 10.1016/j.mri.2017.12.007. Epub 2017 Dec 5.
To evaluate the correlation between the pancreatic exocrine insufficiency estimated by cine-dynamic MRCP using spatially selective IR pulse and the severity stages (modified Cambridge classification) based on morphological changes of the pancreatic duct in patients with suspected chronic pancreatitis.
Thirty-nine patients with suspected chronic pancreatitis underwent cine-dynamic MRCP with a spatially selective IR pulse. The secretion grading score (5-point scale) based on the moving distance of pancreatic juice inflow on cine-dynamic MRCP was assessed, and compared with the stage of the severity of chronic pancreatitis based on morphological changes of pancreatic duct.
The stage of the severity of chronic pancreatitis based on morphological changes had significant negative correlations with the secretion grade (r=-0.698, P<0.001). The secretion grading score of stage 4 was significantly lower than stage 1-3 (P<0.001, P=0.002, P=0.025, respectively). In all 19 patients in stage 4, the secretion grading score was <0.70. The secretion grading score of stage 1 was significantly higher than stage 2 and 4 (P=0.019, P<0.001, respectively). In stage 2, the secretion grading score was <0.70 in 8 (89%) of 9 patients showing pancreatic exocrine insufficiency. Conversely, in stage 3, the secretion grading score was >0.70 in 2 (33%) of 6 patients showing normal pancreatic exocrine function.
It should be noted that the degree of morphological changes of pancreatic duct does not necessarily reflect the severity of pancreatic exocrine insufficiency at cine-dynamic MRCP in stage 2-3 chronic pancreatitis.
评估使用空间选择性反转恢复（IR）脉冲的动态磁共振胰胆管造影（cine-dynamic MRCP）所估计的胰腺外分泌功能不全与疑似慢性胰腺炎患者基于胰管形态学改变的严重程度分期（改良剑桥分类法）之间的相关性。
39例疑似慢性胰腺炎患者接受了使用空间选择性IR脉冲的动态磁共振胰胆管造影检查。评估基于动态磁共振胰胆管造影上胰液流入移动距离的分泌分级评分（5分制），并与基于胰管形态学改变的慢性胰腺炎严重程度分期进行比较。
基于形态学改变的慢性胰腺炎严重程度分期与分泌分级呈显著负相关（r = -0.698，P < 0.001）。4期的分泌分级评分显著低于1 - 3期（分别为P < 0.001、P = 0.002、P = 0.025）。在所有19例4期患者中，分泌分级评分均<0.70。1期的分泌分级评分显著高于2期和4期（分别为P = 0.019、P < 0.001）。在2期，9例存在胰腺外分泌功能不全的患者中有8例（89%）分泌分级评分<0.70。相反，在3期，6例胰腺外分泌功能正常的患者中有2例（33%）分泌分级评分>0.70。
需要注意的是，在2 - 3期慢性胰腺炎的动态磁共振胰胆管造影中，胰管形态学改变的程度不一定反映胰腺外分泌功能不全的严重程度。
