Harrington Kate A, Shukla-Dave Amita, Paudyal Ramesh, Do Richard K G
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Magn Reson Imaging. 2021 Feb;53(2):347-359. doi: 10.1002/jmri.27148. Epub 2020 Apr 17.
MRI has played a critical role in the evaluation of patients with pancreatic pathologies, from screening of patients at high risk for pancreatic cancer to the evaluation of pancreatic cysts and indeterminate pancreatic lesions. The high mortality associated with pancreatic adenocarcinomas has spurred much interest in developing effective screening tools, with MRI using magnetic resonance cholangiopancreatography (MRCP) playing a central role in the hopes of identifying cancers at earlier stages amenable to curative resection. Ongoing efforts to improve the resolution and robustness of imaging of the pancreas using MRI may thus one day reduce the mortality of this deadly disease. However, the increasing use of cross-sectional imaging has also generated a concomitant clinical conundrum: How to manage incidental pancreatic cystic lesions that are found in over a quarter of patients who undergo MRCP. Efforts to improve the specificity of MRCP for patients with pancreatic cysts and with indeterminate pancreatic masses may be achieved with continued technical advances in MRI, including diffusion-weighted and T -weighted dynamic contrast-enhanced MRI. However, developments in quantitative MRI of the pancreas remain challenging, due to the small size of the pancreas and its upper abdominal location, adjacent to bowel and below the diaphragm. Further research is needed to improve MRI of the pancreas as a clinical tool, to positively affect the lives of patients with pancreatic abnormalities. This review focuses on various MR techniques such as MRCP, quantitative imaging, and dynamic contrast-enhanced imaging and their clinical applicability in the imaging of the pancreas, with an emphasis on pancreatic malignant and premalignant lesions. Level of Evidence 5 Technical Efficacy Stage 3 J. MAGN. RESON. IMAGING 2021;53:347-359.
磁共振成像（MRI）在胰腺疾病患者的评估中发挥了关键作用，从筛查胰腺癌高危患者到评估胰腺囊肿和不确定的胰腺病变。胰腺腺癌相关的高死亡率激发了人们对开发有效筛查工具的浓厚兴趣，其中使用磁共振胰胆管造影（MRCP）的MRI在希望在可进行根治性切除的早期阶段识别癌症方面发挥了核心作用。因此，持续努力提高使用MRI对胰腺成像的分辨率和稳健性，也许有一天能降低这种致命疾病的死亡率。然而，横断面成像的使用增加也带来了一个随之而来的临床难题：如何处理在超过四分之一接受MRCP检查的患者中发现的偶然胰腺囊性病变。随着MRI技术的不断进步，包括扩散加权和T加权动态对比增强MRI，有可能提高MRCP对胰腺囊肿和不确定胰腺肿块患者的特异性。然而，由于胰腺体积小且位于上腹部，与肠道相邻且在膈肌下方，胰腺定量MRI的发展仍然具有挑战性。需要进一步研究以改善作为临床工具的胰腺MRI，从而积极影响胰腺异常患者的生活。本综述重点关注各种MR技术，如MRCP、定量成像和动态对比增强成像及其在胰腺成像中的临床适用性，重点是胰腺恶性和癌前病变。证据水平5 技术效能 3期 J. MAGN. RESON. IMAGING 2021;53:347 - 359。
