Gd-DTPA 3D FSPGR MR動態增強在胰腺癌診斷和術前可切除性評估中的價值_《中國普外基礎與臨床雜志》

作者：

趙瓊惠 ¹ , 張小明 ¹ , 曾南林 ¹ , 雷俊陽 ² , 蹇素 ¹

1.川北醫學院附屬醫院放射科（四川南充637000）;;
2.川北醫學院附屬醫院普外科;

關鍵詞：

胰腺癌磁共振成像診斷可切除性

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目的:探討釓噴酸葡胺三維快速擾相梯度回波（Gd-DTPA 3D FSPGR）MR動態增強成像在胰腺癌診斷和術前可切除性評估中的價值。
方法:32例經手術病理證實的胰腺癌，手術前2周行MRI檢查。MRI序列包括脂肪抑制梯度回波T1W（GRE T1W）、快速自旋回波呼吸門控脂肪抑制T2W（FSE RG T2W）、單次激發快速自旋回波T2W（SSFSE T2W）、單次激發自旋快速回波MRI胰膽管成像（MRCP）和Gd-DTPA 3D FSPGR MRI動態增強。回顧性分析胰腺癌的MRI征象，根據腫瘤病灶特征、局部侵犯、血管受累和轉移情況進行可切除性評估，并與手術結果對照分析。
結果:32例中MRI正確診斷29例，準確率達90.6%。腫塊檢出率：脂肪抑制GRE T1W+FSE RG T2W序列為84.4%（27/32）， Gd-DTPA 3D FSPGR動態增強成像為93.8%（30/32）。MRI動態增強成像對胰周血管受累、胰周侵犯評價準確性分別為87.0%（20/23）、87.5%（21/24）；對淋巴結、肝臟轉移和腹膜癌變診斷準確性分別為80.0%（12/15）、88.9%（8/9）及83.3%（5/6）。3D FSPGR動態增強MRI認為手術可切除8例，實際術中切除7例； 24例認為不可切除，實際手術不可切除23例；判斷胰腺癌可切除的敏感性、特異性及準確性分別為87.5%、95.8%及93.8%。
結論:Gd-DTPA 3D FSPGR MR動態增強成像提高了胰腺癌的腫瘤病灶及轉移灶的檢出和定性診斷，評價胰周侵犯和胰周血管受累情況準確性高，判斷其手術可切除性準確率亦高。MRI動態增強對胰腺癌的診斷和術前可切除性評估具有重要的臨床參考價值。

引用本文： 趙瓊惠,張小明,曾南林,雷俊陽,蹇素. Gd-DTPA 3D FSPGR MR動態增強在胰腺癌診斷和術前可切除性評估中的價值. 中國普外基礎與臨床雜志, 2005, 12(3): 301-306. doi: 復制

1.	張群華，倪泉興. 胰腺癌2 340例臨床病例分析 [Ｊ]. 中華醫學雜志, 2004; 84（3）∶214.
2.	吳建新，王興鵬，徐家裕. 胰腺癌流行病學的研究現狀 [Ｊ]. 臨床內科雜志, 2000； 17（3）∶189.
3.	Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3)∶492.
4.	Fischer U, Vosshenrich R, Horstmann O, et al. Preoperative local MRIstaging of patients with a suspected pancreatic mass [Ｊ]. Eur Radiol, 2002; 12(2)∶296.
5.	Obuz F, Dicle O, Coker A, et al. Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging [Ｊ]. Eur J Radiol, 2001; 38(2)∶146.
6.	Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrastenhanced MR imaging and dualphase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis [Ｊ]. AJR Am J Roentgenol, 1999; 173(3)∶583.
7.	張小明. 胰腺癌： MRI檢查技術和診斷 [Ｊ]. 中國醫學計算機成像雜志, 2002； 4（6）∶249.
8.	曾榮蘇，嚴福華，周康榮，等. 磁共振動態增強和脂肪抑制技術在胰腺癌診斷中的價值 [Ｊ]. 臨床放射學雜志, 2000; 19(11)∶703.
9.	Zeng MS,Yan FH,Zhou KR,et al. MR dynamic Gadoliniumenhanced fast multiplanar spoiled gradientecho and spinecho T1weighted fatsuppressed techniques in diagnosis of pancreatic carcinoma [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(2)∶294.
10.	Ishiguchi T, Ota T, Naganawa S, et al. CT and MR imaging of pancreatic cancer [Ｊ]. Hepatogastroenterology, 2001; 48(40)∶923.
11.	Ichikawa T, Haradome H, Hachiya J, et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging [Ｊ]. Radiology, 1997; 202(3)∶655.
12.	Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging [Ｊ]. Radiology, 1999; 212(1)∶213.
13.	Gabata T, Matsui O, Kadoya M, et al. Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement [Ｊ]. Radiology, 1994; 193(3)∶683.
14.	許亮. 慢性胰腺炎與胰腺癌之動態MRI比較 [Ｊ]. 國外醫學臨床放射學分冊, 2000； 23(3)∶179.
15.	Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: assessment with thinsection helical CT versus with breathhold fast MR imaging——ROC analysis [Ｊ]. Radiology, 1999; 212(2)∶445.
16.	Helmreich F, Schniewind B, Biederer J, et al. The role of magnetic resonance imaging in the preoperative evaluation of the peripancreatic vasculature in pancreas carcinoma [Ｊ]. Rofo, 2004; 176(2)∶239.
17.	Fayad LM, Mitchell DG. Magnetic resonance imaging of pancreatic adenocarcinoma [Ｊ]. Int J Gastrointest Cancer, 2001; 30(1-2)∶19.
18.	Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [Ｊ]. Radiology, 2002; 224(1)∶34.
19.	Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors [Ｊ]. Ann Surg, 1997; 226(4)∶393.
20.	Catalano C, Pavone P, Laghi A, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability [Ｊ]. Eur Radiol, 1998; 8(3)∶428.
21.	龔靜山，周康榮. MR動態增強掃描對胰腺癌的應用價值 [Ｊ]. 國外醫學臨床放射學分冊, 2001; 24(5)∶269.

1. 張群華，倪泉興. 胰腺癌2 340例臨床病例分析 [Ｊ]. 中華醫學雜志, 2004; 84（3）∶214.
2. 吳建新，王興鵬，徐家裕. 胰腺癌流行病學的研究現狀 [Ｊ]. 臨床內科雜志, 2000； 17（3）∶189.
3. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3)∶492.
4. Fischer U, Vosshenrich R, Horstmann O, et al. Preoperative local MRIstaging of patients with a suspected pancreatic mass [Ｊ]. Eur Radiol, 2002; 12(2)∶296.
5. Obuz F, Dicle O, Coker A, et al. Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging [Ｊ]. Eur J Radiol, 2001; 38(2)∶146.
6. Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrastenhanced MR imaging and dualphase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis [Ｊ]. AJR Am J Roentgenol, 1999; 173(3)∶583.
7. 張小明. 胰腺癌： MRI檢查技術和診斷 [Ｊ]. 中國醫學計算機成像雜志, 2002； 4（6）∶249.
8. 曾榮蘇，嚴福華，周康榮，等. 磁共振動態增強和脂肪抑制技術在胰腺癌診斷中的價值 [Ｊ]. 臨床放射學雜志, 2000; 19(11)∶703.
9. Zeng MS,Yan FH,Zhou KR,et al. MR dynamic Gadoliniumenhanced fast multiplanar spoiled gradientecho and spinecho T1weighted fatsuppressed techniques in diagnosis of pancreatic carcinoma [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(2)∶294.
10. Ishiguchi T, Ota T, Naganawa S, et al. CT and MR imaging of pancreatic cancer [Ｊ]. Hepatogastroenterology, 2001; 48(40)∶923.
11. Ichikawa T, Haradome H, Hachiya J, et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging [Ｊ]. Radiology, 1997; 202(3)∶655.
12. Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging [Ｊ]. Radiology, 1999; 212(1)∶213.
13. Gabata T, Matsui O, Kadoya M, et al. Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement [Ｊ]. Radiology, 1994; 193(3)∶683.
14. 許亮. 慢性胰腺炎與胰腺癌之動態MRI比較 [Ｊ]. 國外醫學臨床放射學分冊, 2000； 23(3)∶179.
15. Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: assessment with thinsection helical CT versus with breathhold fast MR imaging——ROC analysis [Ｊ]. Radiology, 1999; 212(2)∶445.
16. Helmreich F, Schniewind B, Biederer J, et al. The role of magnetic resonance imaging in the preoperative evaluation of the peripancreatic vasculature in pancreas carcinoma [Ｊ]. Rofo, 2004; 176(2)∶239.
17. Fayad LM, Mitchell DG. Magnetic resonance imaging of pancreatic adenocarcinoma [Ｊ]. Int J Gastrointest Cancer, 2001; 30(1-2)∶19.
18. Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [Ｊ]. Radiology, 2002; 224(1)∶34.
19. Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors [Ｊ]. Ann Surg, 1997; 226(4)∶393.
20. Catalano C, Pavone P, Laghi A, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability [Ｊ]. Eur Radiol, 1998; 8(3)∶428.
21. 龔靜山，周康榮. MR動態增強掃描對胰腺癌的應用價值 [Ｊ]. 國外醫學臨床放射學分冊, 2001; 24(5)∶269.

《中國普外基礎與臨床雜志》

Gd-DTPA 3D FSPGR MR動態增強在胰腺癌診斷和術前可切除性評估中的價值

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《中國普外基礎與臨床雜志》

Gd-DTPA 3D FSPGR MR動態增強在胰腺癌診斷和術前可切除性評估中的價值

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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