用于诊断慢性胰腺炎的胰腺多参数磁共振成像评分系统
Multiparametric MRI Scoring System of the Pancreas for the Diagnosis of Chronic Pancreatitis.
作者信息
Tirkes Temel, Yadav Dhiraj, Conwell Darwin L, Zhao Xuandong, Dasyam Anil K, Halappa Vivek Gowdra, Patel Aashish, Shah Zarine K, Swensson Jordan, Takahashi Naoki, Venkatesh Sudhakar, Wachsman Ashley, Li Liang, Jennings Kristofer, Yang Yunlong, Hart Phil A, Pandol Stephen J, Park Walter G, Vege Santhi Swaroop, Topazian Mark, Territo Paul R, Persohn Scott A, Andersen Dana K, Fogel Evan L
机构信息
Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
出版信息
J Magn Reson Imaging. 2025 May;61(5):2183-2194. doi: 10.1002/jmri.29594. Epub 2024 Sep 3.
BACKGROUND
Ductal features alone may not offer high diagnostic sensitivity or most accurate disease severity of chronic pancreatitis (CP).
PURPOSE
Diagnose CP based on multiparametric MRI and MRCP features.
STUDY TYPE
Prospective.
POPULATION
Between February 2019 and May 2021, 46 control (23 males, 49.3 ± 14.1 years), 45 suspected (20 males, 48.7 ± 12.5 years), and 46 definite (20 males, 53.7 ± 14.6 years) CP patients were enrolled at seven hospitals enrolled in the MINIMAP study. CP classification was based on imaging findings and clinical presentation.
FIELD STRENGTH AND SEQUENCES
1.5 T. T-weighted (TW) spoiled gradient echo, T1 map with variable flip angle, dual-echo Dixon, secretin-enhanced MRCP before and after secretin infusion.
ASSESSMENT
Dual-echo fat fraction (FF), T relaxation time, extracellular volume (ECV), T signal intensity ratio of the pancreas to the spleen (T score), arterial-to-venous enhancement ratio (AVR), pancreatic tail diameter (PTD), pancreas volume, late gadolinium enhancement, pancreatic ductal elasticity (PDE), and duodenal filling grade of secretin-enhanced MRCP were measured.
STATISTICAL TESTS
Logistic regression analysis generated CP-MRI and secretin-enhanced CP-SMRI scores. Receiver operating characteristics analysis was used to differentiate definite CP from control. Interobserver agreement was assessed using Lin's concordance correlation coefficient.
RESULTS
Compared to control, definite CP cohort showed significantly higher dual-echo FF (7% vs. 11%), lower AVR (1.35 vs. 0.85), smaller PTD (2.5 cm vs. 1.95 cm), higher ECV (28% vs. 38%), and higher incidence of PDE loss (6.5% vs. 50%). With the cut-off of >2.5 CP-MRI score (dual-echo FF, AVR, and PTD) and CP-SMRI score (dual-echo FF, AVR, PTD, and PDE) had cross-validated area under the curves of 0.84 (sensitivity 87%, specificity 68%) and 0.86 (sensitivity 89%, specificity 67%), respectively. Interobserver agreement for both CP-MRI and CP-SMRI scores was 0.74.
CONCLUSION
The CP-MRI and CP-SMRI scores yielded acceptable performance and interobserver agreement for the diagnosis of CP.
EVIDENCE LEVEL
1 TECHNICAL EFFICACY: Stage 2.
背景
仅依靠导管特征可能无法对慢性胰腺炎（CP）提供高诊断敏感性或最准确的疾病严重程度评估。
目的
基于多参数MRI和MRCP特征诊断CP。
研究类型
前瞻性研究。
研究对象
在参与MINIMAP研究的七家医院中，于2019年2月至2021年5月期间纳入了46名对照者（23名男性，年龄49.3±14.1岁）、45名疑似CP患者（20名男性，年龄48.7±12.5岁）和46名确诊CP患者（20名男性，年龄53.7±14.6岁）。CP分类基于影像学表现和临床表现。
场强与序列
1.5T。T加权（TW）扰相梯度回波序列、可变翻转角T1图谱、双回波狄克逊序列、注射促胰液素前后的促胰液素增强MRCP序列。
评估指标
测量双回波脂肪分数（FF）、T2弛豫时间、细胞外容积（ECV）、胰腺与脾脏的T2信号强度比（T评分）、动脉期与静脉期强化率（AVR）、胰尾直径（PTD）、胰腺体积、钆剂延迟强化、胰管弹性（PDE）以及促胰液素增强MRCP的十二指肠充盈程度。
统计分析
采用逻辑回归分析生成CP-MRI和促胰液素增强CP-SMRI评分。采用受试者工作特征分析来区分确诊CP与对照者。使用林氏一致性相关系数评估观察者间的一致性。
结果
与对照组相比，确诊CP组的双回波FF显著更高（7%对11%）、AVR更低（1.35对0.85）、PTD更小（2.5cm对1.95cm）、ECV更高（28%对38%）以及PDE丧失的发生率更高（6.5%对50%）。CP-MRI评分（双回波FF、AVR和PTD）和CP-SMRI评分（双回波FF、AVR、PTD和PDE）的截断值>2.5时，曲线下交叉验证面积分别为0.84（敏感性87%，特异性68%）和0.86（敏感性89%，特异性67%）。CP-MRI和CP-SMRI评分的观察者间一致性为0.74。
结论
CP-MRI和CP-SMRI评分在CP诊断中表现出可接受的性能和观察者间一致性。
证据水平
1级 技术效能：2级
Zotero 插件