DWI聯合3D-VIBE序列評價肝門膽管癌淋巴結轉移_《中國普外基礎與臨床雜志》

作者：

伍東升 ¹ , 王曉東 ¹ , 陳衛霞 ¹ , 彭瑾 ¹ , 蘇偉 ² , 張洪靜 ¹

1.四川大學華西醫院放射科（四川成都 610041）;;
2.四川大學華西醫院病理科（四川成都 610041）;

關鍵詞：

磁共振成像彌散加權成像三維容積內插值屏氣檢查肝門膽管癌淋巴結轉移

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目的探討磁共振彌散加權成像（DWI）聯合三維容積內插值屏氣檢查（3D-VIBE）在評價肝門膽管癌淋巴結轉移中的價值。方法收集2009年7月至2011年3月行上腹部磁共振成像（MRI）檢查并經手術、病理學檢查證實的連續性肝門膽管癌病例37例，比較DWI和VIBE序列對淋巴結顯示的差異，分析淋巴結的形態及分布情況。在DWI序列上測量淋巴結的信號強度（SI）并計算表觀彌散系數（ADC），在3D-VIBE圖像上測量淋巴結與肝實質SI之比（SI淋巴結/SI肝臟），對轉移性與非轉移性淋巴結的差異進行比較。結果37例患者59組淋巴結中，51組在DWI和3D-VIBE序列上均顯示，8組僅在一種序列圖像上顯示，兩種序列圖像淋巴結顯示率的差異無統計學意義（P=0.070）。在DWI軸位像和3D-VIBE增強掃描圖像上，所有顯示淋巴結的短徑分別為（0.82±0.27） cm和（0.79±0.26） cm，兩者的差異無統計學意義（P=0.628）。3D-VIBE圖像上，轉移性淋巴結的短徑為（1.05±0.42） cm，明顯大于非轉移性淋巴結〔(0.78±0.22) cm〕，P=0.030。轉移性淋巴結的ADC值為（1.64±0.30）×10-3 mm2/s，明顯小于非轉移性淋巴結的ADC值〔(2.28±0.79)×10-3 mm2/s〕，P=0.033。動態增強掃描門靜脈期轉移性與非轉移性淋巴結的SI淋巴結/SI肝臟分別為1.24±0.31和1.33±0.25，3 min延遲期轉移性與非轉移性淋巴結的SI淋巴結/SI肝臟分別為1.34±0.28和1.19±0.15，差異均無統計學意義（P=0.368，P=0.081）。在DWI序列圖像中，隨著b值增大，圖像的SI逐漸降低。結論DWI和3D-VIBE序列檢測的ADC值及淋巴結短徑的差異對于鑒別肝門膽管癌淋巴結轉移具有一定價值，聯合DWI、3D-VIBE序列能夠更準確地評價肝門膽管癌淋巴結轉移情況。

引用本文： 伍東升,王曉東,陳衛霞,彭瑾,蘇偉,張洪靜. DWI聯合3D-VIBE序列評價肝門膽管癌淋巴結轉移. 中國普外基礎與臨床雜志, 2011, 18(7): 773-778. doi: 復制

1.	Miyazaki M, Ito H, Nakagawa K, et al. Parenchymapreserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma [J]. J Am Coll Surg, 1999, 189(6): 575583.
2.	Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3): 385392.
3.	孫學軍，石景森，何平．影響膽管癌切除術后的預后因素分析 [J]．中國普外基礎與臨床雜志，2006， 13（1）： 8588．.
4.	黃志強．肝門部膽管癌的外科治療與發展 [J]．中國普外基礎與臨床雜志， 2003， 10（5）： 425428．.
5.	李潔，張曉鵬，曹崑，等．乳腺 MR動態增強掃描聯合擴散加權成像的臨床應用評價 [J]．中國醫學影像技術， 2005， 21（12）： 18211825．.
6.	張曉鵬，曹崑，唐磊．子宮內膜癌和正常子宮擴散加權成像信號強度與 ADC值關系的研究 [J]．中國醫學影像技術， 2005， 21（12）： 18441847．.
7.	Starlack JM, Adalsteinsson E, Adam MF, et al. In vivo 1H MR spectroscopy of human head and neck lymph node metastasis and comparison with oxygen tension measurements [J]. AJNR Am J Neuroradiol, 2000, 21(1): 183193.
8.	梁穎，羅德紅，吳寧，等．頸部惡性淋巴結的多層螺旋 CT 灌注研究 [J]．中華放射學雜志， 2004， 38（11）： 11931197．.
9.	Fischbein NJ, Noworolski SM, Henry RG, et al. Assessment of metastatic cervical adenopathy using dynamic contrastenhanced MR imaging [J]. AJNR Am J Neuroradiol, 2003, 24(3): 301311.
10.	叢冠寧，秦明偉，賀丹，等．高分辨MRI對直腸癌TNM分期及環周切緣的評估 [J]．中國普外基礎與臨床雜志， 2010， 17（9）： 894900．.
11.	Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
12.	Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer:application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [J]. Ann Surg, 2003, 238(1): 8492.
13.	Bismuth H, Majno PE. Hepatobiliary surgery [J]. J Hepatol, 2000, 32(1 Suppl): 208224.
14.	黃志強．肝門部膽管癌外科治療的現狀與展望 [J]．中國普外基礎與臨床雜志， 2005， 12（4）： 317320．.
15.	Lee HY, Kim SH, Lee JM, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma:combined CT and cholangiography with revised criteria[J]. Radiology, 2006, 239(1): 113121.
16.	Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging [J]. J Nucl Med, 2004, 45(9): 15091518.
17.	Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis [J]. AJR Am J Roentgenol, 1992, 158(5): 961969.
18.	Yousem DM, Som PM, Hackney DB, et al. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT [J]. Radiology, 1992, 182(3): 753759.
19.	Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
20.	Kim JK, Kim KA, Park BW, et al. Feasibility of diffusionweighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience [J]. J Magn Reson Imaging, 2008, 28(3): 714719.
21.	Nasu K, Kuroki Y, Nawano S, et al. Hepatic metastases:diffusionweighted sensitivityencoding versus SPIOenhanced MR imaging[J]. Radiology, 2006, 239(1): 122130.
22.	Vandecaveye V, De KF, Nuyts S, et al. Detecting nodal metastases in primary head and neck cancer with diffusionweighted MRI: initial experience [J]. Cancer Imaging, 2006, 6(Spec No A): S96S101.
23.	張赟，梁碧玲，高立，等．頸部淋巴結的 MR擴散加權成像 [J]．臨床放射學雜志， 2007， 26（3）： 244247．.
24.	Ichikawa T, Haradome H, Hachiya J, et al. Diffusionweighted MR imaging with singleshot echoplanar imaging in the upper abdomen: preliminary clinical experience in 61 patients [J]. Abdom Imaging, 1999, 24(5): 456461.
25.	Yin LL, Song B, Xu J, et al. Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breathhold examination magnetic resonance imaging sequence [J]. Chin Med J (Engl), 2007, 120(8): 636642.
26.	Engels JT, Balfe DM, Lee JK. Biliary carcinoma: CT evaluation of extrahepatic spread [J]. Radiology, 1989, 172(1): 3540.
27.	Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning [J]. Abdom Imaging, 2008, 33(4): 444451.

1. Miyazaki M, Ito H, Nakagawa K, et al. Parenchymapreserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma [J]. J Am Coll Surg, 1999, 189(6): 575583.
2. Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3): 385392.
3. 孫學軍，石景森，何平．影響膽管癌切除術后的預后因素分析 [J]．中國普外基礎與臨床雜志，2006， 13（1）： 8588．.
4. 黃志強．肝門部膽管癌的外科治療與發展 [J]．中國普外基礎與臨床雜志， 2003， 10（5）： 425428．.
5. 李潔，張曉鵬，曹崑，等．乳腺 MR動態增強掃描聯合擴散加權成像的臨床應用評價 [J]．中國醫學影像技術， 2005， 21（12）： 18211825．.
6. 張曉鵬，曹崑，唐磊．子宮內膜癌和正常子宮擴散加權成像信號強度與 ADC值關系的研究 [J]．中國醫學影像技術， 2005， 21（12）： 18441847．.
7. Starlack JM, Adalsteinsson E, Adam MF, et al. In vivo 1H MR spectroscopy of human head and neck lymph node metastasis and comparison with oxygen tension measurements [J]. AJNR Am J Neuroradiol, 2000, 21(1): 183193.
8. 梁穎，羅德紅，吳寧，等．頸部惡性淋巴結的多層螺旋 CT 灌注研究 [J]．中華放射學雜志， 2004， 38（11）： 11931197．.
9. Fischbein NJ, Noworolski SM, Henry RG, et al. Assessment of metastatic cervical adenopathy using dynamic contrastenhanced MR imaging [J]. AJNR Am J Neuroradiol, 2003, 24(3): 301311.
10. 叢冠寧，秦明偉，賀丹，等．高分辨MRI對直腸癌TNM分期及環周切緣的評估 [J]．中國普外基礎與臨床雜志， 2010， 17（9）： 894900．.
11. Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
12. Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer:application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [J]. Ann Surg, 2003, 238(1): 8492.
13. Bismuth H, Majno PE. Hepatobiliary surgery [J]. J Hepatol, 2000, 32(1 Suppl): 208224.
14. 黃志強．肝門部膽管癌外科治療的現狀與展望 [J]．中國普外基礎與臨床雜志， 2005， 12（4）： 317320．.
15. Lee HY, Kim SH, Lee JM, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma:combined CT and cholangiography with revised criteria[J]. Radiology, 2006, 239(1): 113121.
16. Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging [J]. J Nucl Med, 2004, 45(9): 15091518.
17. Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis [J]. AJR Am J Roentgenol, 1992, 158(5): 961969.
18. Yousem DM, Som PM, Hackney DB, et al. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT [J]. Radiology, 1992, 182(3): 753759.
19. Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
20. Kim JK, Kim KA, Park BW, et al. Feasibility of diffusionweighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience [J]. J Magn Reson Imaging, 2008, 28(3): 714719.
21. Nasu K, Kuroki Y, Nawano S, et al. Hepatic metastases:diffusionweighted sensitivityencoding versus SPIOenhanced MR imaging[J]. Radiology, 2006, 239(1): 122130.
22. Vandecaveye V, De KF, Nuyts S, et al. Detecting nodal metastases in primary head and neck cancer with diffusionweighted MRI: initial experience [J]. Cancer Imaging, 2006, 6(Spec No A): S96S101.
23. 張赟，梁碧玲，高立，等．頸部淋巴結的 MR擴散加權成像 [J]．臨床放射學雜志， 2007， 26（3）： 244247．.
24. Ichikawa T, Haradome H, Hachiya J, et al. Diffusionweighted MR imaging with singleshot echoplanar imaging in the upper abdomen: preliminary clinical experience in 61 patients [J]. Abdom Imaging, 1999, 24(5): 456461.
25. Yin LL, Song B, Xu J, et al. Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breathhold examination magnetic resonance imaging sequence [J]. Chin Med J (Engl), 2007, 120(8): 636642.
26. Engels JT, Balfe DM, Lee JK. Biliary carcinoma: CT evaluation of extrahepatic spread [J]. Radiology, 1989, 172(1): 3540.
27. Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning [J]. Abdom Imaging, 2008, 33(4): 444451.

《中國普外基礎與臨床雜志》

DWI聯合3D-VIBE序列評價肝門膽管癌淋巴結轉移

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《中國普外基礎與臨床雜志》

DWI聯合3D-VIBE序列評價肝門膽管癌淋巴結轉移

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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