论文部分内容阅读
目的 探讨多种MR成像技术对胰腺癌诊断及其手术可切除性判断的价值。 方法 18例经手术和/或病理证实的胰腺癌患者进行了磁共振检查,采用的磁共振序列分别为:GRE T_1WI,TSE T_2WI,脂肪抑制GRE T_1WI,延迟增强GRE T_1WI,磁共振胰胆管造影(MRCP)和三维动态对比增强MRA(3D DCE MRA)。肿瘤累及胰周血管根据程度依次分为0～4级。 结果 18例胰腺癌肿瘤病灶,在GRE T_1WI上均呈稍低信号,TSE T_2WI上均呈稍高信号。脂肪抑制GRE T_1WI上所有肿瘤均呈明 显低信号,延迟增强GRE T_1WI上肿瘤表现环形不规则强化14例,均匀强化4例,但均低于正常胰腺强化。MRCP显示胆总管与主胰管均扩张表现为典型“双管征”8例。在3D DCE MRA上,根据肿瘤与血管周径接触面>1/2为不能切除的标准,则门静脉受累56％(10/18),脾静脉受累39％(7/18),肠系膜上静脉受累67％(12/18),腹腔干及主要分支受累22％(4/18)及肠系膜上动脉受累17％(3/18)。MRI判断2例可完全手术切除,与手术结果相符。 结论 MRI快速扫描序列、脂肪抑制技术、MRCP及3D DCE MRA四大MR成像技术的综合应用能提供胰腺癌诊断及手术可切除性判断的必需信息,可以达到一步到位的诊断目标。
Objective To explore the value of MR imaging in the diagnosis of pancreatic cancer and its resectability. Methods 18 cases of patients with pancreatic cancer confirmed by operation and / or pathology were examined by MRI. The magnetic resonance sequences were GRE T_1WI, TSE T_2WI, GRE T_1WI with fat suppression, GRE T_1WI with delay enhancement, magnetic resonance cholangiopancreatography MRCP) and three-dimensional dynamic contrast-enhanced MRA (3D DCE MRA). Tumors involving the peripancreatic vessels are divided into 0 ~ 4 according to the degree. Results Eighteen cases of pancreatic cancer showed lesser signal on GRE T_1WI and slightly higher signal on TSE T_2WI. All tumors in fat suppression GRE T_1WI showed a significantly lower signal, delay enhancement in GRE T_1WI tumor irregular ring enhancement in 14 cases, uniform enhancement in 4 cases, but were lower than normal pancreatic enhancement. MRCP showed that the common bile duct and main pancreatic duct were all expanded in the typical “double-tube sign” in 8 cases. On 3D DCE MRA, portal vein involvement was 56% (10/18), splenic vein involvement was 39% (7/18), and mesenteric vein involvement 67% (12/18), celiac and major branches involved 22% (4/18) and superior mesenteric artery involvement 17% (3/18). 2 cases of MRI can be completely resected, consistent with the surgical results. Conclusion The comprehensive application of the four MR imaging techniques, such as rapid scanning sequence, fat suppression, MRCP and 3D DCE MRA, can provide the necessary information for the diagnosis of pancreatic cancer and the resectability of the surgical resection, which can reach the diagnostic goal of one step.