MRI对胰腺癌胰周血管侵犯的手术可切除性评价

目的对胰腺癌胰周血管侵犯判断的最佳序列进行评价，并探讨MRI判断胰腺癌胰周血管侵犯的敏感性、特异性及准确性。资料与方法搜集22例经手术病理证实的胰腺癌病例，所有患者均行平扫的SET1WI、FSE T2WI、SE T1WI＋FS序列扫描，同时行动态增强GRE（DCE FMPSPGR）序列的三期扫描。对该22例患者术前胰周血管侵犯情况进行回顾性分析：（1）按照肿瘤对周围血管侵犯的程度，采用0～3级的等级法进行术前盲法评分，统计血管侵犯及无侵犯的支数，并同手术结果对照。分析0～3各级别对于血管侵犯与否判断其敏感性。（2）统计SE T1WI及DCE FMPSPGR两序列分别及结合起来评价胰周血管侵犯敏感性、特异性、阳性预测值、阴性预测值及准确性。结果22例患者7段共154支血管中，术中发现51支有侵犯，103支无侵犯。其中WE T1WI术前诊断45支受侵．109支无侵犯，漏诊6支，误诊3支。DCEFMPSPCR诊断43支受侵．111支正常，漏诊8支，误诊2支。WE T1WI和DCE FMPSPGR分别及两者相结合判断血管受侵的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为：88．2％、97％、93．8％、94．3％、94．2％；84．3％、98．0％、95．5％、92．7％、93．5％；92．1％、98．0％、95．9％、96．2％、96．1％。结论MRI判断胰周血管侵犯的敏感性为92．1％，特异性为98．0％，诊断准确性96．1％。以SE T1WI和DCE FMPSPGR两序列较优，两者结合起来可以提高判断的准确性。

Pancreatic Carcinoma Invasion to Peripancreatic Vessels: Evaluation the Resectability with MRI

Objective To discuss the sensitivity, specificity and accuracy of MRI in evaluating the invasion of pancreatic carcinoma to surrounding vessels, and further evaluate the optimal scanning sequences.Materials and Methods 22 cases of pancreatic carcinomas verified with surgical pathology were collected, MRI sequences such as SE T_1WI, FSE T_2WI, FSE T_1W FS and dynamic contrast enhanced GRE triphase scans were performed. The invasion of peripancreatic vessels were retrospectively analyzed: (1)According to the degree of invasion, grading method as 0-3 grades was employed for blinded scoring, the numbers of vessels invasion and non-invasion were calculated, and compared with the surgical-pathology results, the accuracy of each grade for vessels invasion were analyzed. (2) The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for SE T_1WI and DCE FMPSPGR were also calculated respectively.Results Totally, 154 vessels of 22 cases were involved, 51 vessels were invasive and 103 vessels were non-invasive. 45 vessels were invasive, 109 vessels were non-invasive and 6 vessels were misdiagnosed by SE T_1W. 43 vessels were invasive, 111 vessels were non-invasive and 2 vessels were misdiagnosed by DCE FMPSPGR. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SE T_1WI and DCE FMPSPGR and SE T_1WI DCE FMPSPGR for vessels invasion were: 88.2%, 97.0%, 93.8%, 94.3%, 94.2%; 84.3%, 98.0%, 95.5%, 92.7%, 93.5%; 92.1%, 98.0%, 95.9%, 96.2%, 96.1% respectively.Conclusion The sensitivity, specificity and accuracy of MRI for peripancreatic vessels invasion were 92.1%, 98.0% and 96.1% respectively. SE T_1W and DCE FMPSPGR sequence are better for detection of peripancreatic vessels invasion, combined with SE T_1W and DCE FMPSPGR sequence could improve the accuracy of diagnosis.