Murakami K, Nawano S, Moriyama N, Sekiguchi R, Satake M, Iwata R, Hayashi T, Nemoto K
Department of Radiology, Funabashi Central Hospital.
Nihon Igaku Hoshasen Gakkai Zasshi. 1997 Aug;57(9):596-601.
Single breath-hold gradient echo images were obtained before and immediately after bolus intravenous administration of Gd-DTPA (dynamic MR imaging) in the study of the pancreas. Of 37 patients with pathologically proved pancreatic ductal adenocarcinoma, seventeen patients who underwent both dynamic MR imaging studies and curative surgery were included in this study. Correlations between histologic findings in the resected specimens and MR images were analyzed as to tumor extension and staging according to the General Rules for the Study of Pancreatic Cancer (4th Edition) published by the Japan Pancreas Society. In comparison with conventional MR images, dynamic MR imaging improved the detectability of pancreatic carcinoma and delineation of the vasculature by clarifying the margin of the tumor and the vessels. Nonenhanced T1-weighted imaging is the best sequence to estimate peripancreatic tumor extension, because the contrast between the tumor and peripancreatic fat deteriorates with the use of contrast material. There is a tendency to overestimate vascular invasion on MR images, the reason for which is considered to be the contractive nature of fibrotic change induced by pancreatic carcinoma. The diagnostic efficacy of lymph node metastasis remains insufficient on MR images because some cases show no enlargement of lymph nodes in spite of the existence of pathological metastasis. Our results suggest that dynamic MR imaging has the advantage of improving the conspicuity of the tumor and the vasculature.
在胰腺研究中，于静脉团注钆喷酸葡胺之前及之后即刻获取单次屏气梯度回波图像（动态磁共振成像）。在37例经病理证实为胰腺导管腺癌的患者中，本研究纳入了17例既接受了动态磁共振成像检查又接受了根治性手术的患者。根据日本胰腺学会发布的《胰腺癌研究总则（第4版）》，对切除标本的组织学 findings与磁共振图像之间在肿瘤侵犯范围和分期方面的相关性进行了分析。与传统磁共振图像相比，动态磁共振成像通过清晰显示肿瘤和血管的边界，提高了胰腺癌的可检测性以及血管系统的清晰度。非增强T1加权成像对于评估胰腺周围肿瘤侵犯范围是最佳序列，因为使用对比剂后肿瘤与胰腺周围脂肪之间的对比度会降低。磁共振图像上存在高估血管侵犯的倾向，其原因被认为是胰腺癌诱导的纤维化改变的收缩特性。磁共振图像上淋巴结转移的诊断效能仍然不足，因为尽管存在病理转移，但有些病例的淋巴结并未肿大。我们的结果表明，动态磁共振成像具有提高肿瘤和血管清晰度的优势。
