CT、MRI增强扫描对胰腺癌与慢性胰腺炎的鉴别诊断价值

摘要/Abstract

摘要： 目的评估磁共振成像（MRI）增强扫描、电子计算机断层增强扫描（CT）及二者联合对胰腺癌和慢性胰腺炎的鉴别诊断价值。方法选取2018年6月—2023年6月于通辽市科尔沁区第一人民医院就诊的50例胰腺癌患者和65例慢性胰腺炎患者作为研究对象,均行CT和MRI增强扫描检查,以病理诊断结果为金标准,采用Kappa一致性检验法评估CT、MRI及二者联合对胰腺癌和慢性胰腺炎鉴别诊断结果与病理诊断结果的一致性。结果 CT：慢性胰腺炎局部表现为胰腺体积缩小,多为不规则或分叶状、边缘粗糙的肿块;出现粗大、广泛、弥散性分布的点片状钙化,胰腺实质密度均匀或局部下降。胰腺癌多表现为在局部增大的胰腺基础上形成实质性肿块,边缘光滑,一般无分叶;较少钙化;腺体呈弥漫或局部肿大,呈等或稍低密度。MRI：慢性胰腺炎T1WI呈低信号,T2WI信号混杂,偶为高信号;增强扫描后呈斑点状弱或无强化。胰腺癌T1WI呈低或稍低信号,T2WI呈高或等高信号,胰胆管呈不规则扩张;增强扫描后呈不均匀、低强化。与慢性胰腺炎患者相比,胰腺癌患者胰腺体积增大、侵袭周围组织及大血管、周围淋巴结肿大、胰胆管不规则扩张发生率高,病变侵袭周围囊肿、病变组织钙化、延迟期强化发生率低,差异有统计学意义（P<0.05）。胰腺癌患者动脉期、胰腺期、延迟期的CT值较慢性胰腺炎患者低,差异有统计学意义（P<0.05）。CT联合MRI增强扫描诊断胰腺癌、慢性胰腺炎的准确率分别为96.00%（48/50）、96.92%（63/65）,高于CT诊断的74.00%（37/50）、70.77%（46/65）和MRI增强扫描的86.00%（43/50）、75.38%（49/65）,且CT联合MRI增强扫描鉴别诊断胰腺癌、慢性胰腺炎的Kappa值为0.829,高于CT、MRI增强扫描单独鉴别诊断的0.548、0.614。结论 CT、MRI增强扫描对胰腺癌、慢性胰腺炎的鉴别诊断价值均较好,但二者联合可提供更高的诊断效能。

关键词: 胰腺癌, 慢性胰腺炎, 计算机断层扫描, 磁共振成像增强扫描, 鉴别诊断

Abstract: Objective To evaluate the differential diagnostic value of magnetic resonance imaging (MRI) enhanced scanning, computed tomography (CT) and their combination in pancreatic cancer and chronic pancreatitis. Methods A total of 50 patients with pancreatic cancer and 65 patients with chronic pancreatitis who visited the hospital in June 2018~June 2023 were selected as the research subjects, and CT and MRI enhanced scanning were performed, and the Kappa consistency test was used to evaluate the consistency of CT, MRI and the combination of the two on the differential diagnosis results and pathological diagnosis results of pancreatic cancer and chronic pancreatitis. Results CT: Chronic pancreatitis was locally manifested as a reduction in the size of the pancreate, mostly irregular or lobulated masses with rough edges. Large, extensive,diffuse distribution of spot-like calcifications occur, and pancreatic parenchymal density is uniform or locally reduced. Pancreatic cancer is mostly manifested as the formation of a substantial mass on the basis of a locally enlarged pancreas, with smooth edges and generally no pagination; Less calcification; The gland is diffuse or locally enlarged, with equal or slightly lower density. MRI: chronic pancreatitis T1WI showed low signal, T2WI signal was mixed, and occasionally high signal; weak or no enhancement on contrast-enhanced scanning; Pancreatic cancer T1WI showed low or slightly lower signal, T2WI showed high or isoheight signal, and pancreatic bile ducts were irregularly dilated; Enhanced scanning is uneven, with low intensification. Compared with patients with chronic pancreatitis, patients with pancreatic cancer had a higher incidence of increased pancreatic size, invasion of surrounding tissues and large blood vessels, swelling of peripheral lymph nodes, irregular expansion of pancreatobiliary ducts, and lower incidence of lesion invasion of peripheral cysts, calcification of diseased tissues,and delayed intensification (P<0.05). The CT values of arterial, pancreatic and delayed phases in patients with pancreatic cancer were lower than those in patients with chronic pancreatitis (P<0.05). The accuracy rates of CT combined with MRI enhanced scan in the diagnosis of pancreatic cancer and chronic pancreatitis were 96.00% (48/50) and 96.92% (63/65), respectively, which were higher than the 74.00% (37/50), 70.77% (46/65) of CT diagnosis and 86.00% (43/50) and 75.38% (49/65) of MRI enhanced scan, and CT combined with MRI enhanced scan for differential diagnosis of pancreatic cancer. The Kappa value of chronic pancreatitis was 0.829, which was higher than that of 0.548 and 0.614 for differential diagnosis by CT and MRI enhanced scan. Conclusion CT and MRI enhanced scanning have good differential diagnostic value for pancreatic cancer and chronic pancreatitis, but the combination of the two can provide higher diagnostic efficiency.

Key words: pancreatic cancer, chronic pancreatitis, computed tomography, MRI-enhanced scanning, differential diagnosis

中图分类号:

R735.9

侯胜楠. CT、MRI增强扫描对胰腺癌与慢性胰腺炎的鉴别诊断价值[J]. 中华养生保健, 2024, 42(7): 176-180.

HOU Sheng-nan. CT and MRI Enhanced Scanning for the Differential Diagnosis between Pancreatic Cancer and Chronic Pancreatitis[J]. ZHONGHUA YANGSHENG BAOJIAN, 2024, 42(7): 176-180.

参考文献

[1] YAMAGUCHI J, YOKOYAMA Y, FUJII T, et al.Results of a phase II study on the use of neoadjuvant chemotherapy (FOLFIRINOX or GEM/nab-PTX) for borderline-resectable pancreatic cancer (NUPAT-01)[J].Ann Surg,2022,275(6):1043-1049.
[2] 李昊. 多层螺旋CT和磁共振成像检查对胰腺癌的诊断价值[J].影像研究与医学应用,2021,5(10):93-94.
[3] KANDIKATTU H K, VENKATESHAIAH S U, MISHRA A.Chronic pancreatitis and the development of pancreatic cancer[J]. Endocr Metab Immune Disord Drug Targets,2020,20(8):1182-1210.
[4] 廖燕庭. 动态螺旋CT增强扫描影像对慢性肿块型胰腺炎的鉴别诊断价值分析[J].影像研究与医学应用,2021,5(17):70-71.
[5] SCHIMA W, BOHM G, ROSCH C S, et al.Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation[J]. Cancer Imaging,2020,20(1):52.
[6] 于文越,秦晔.CT、MRI对胰腺囊性病变的鉴别诊断价值分析[J].中国CT和MRI杂志,2022,20(3):86-88.
[7] 李斌,王均庆,陆风旗,等.术前CT与MRI检查评估壶腹周围癌相邻器官侵犯的临床应用价值[J].中华消化外科杂志,2020,19(3):336-344.
[8] 国家卫生健康委办公厅.胰腺癌诊疗指南(2022年版)[J].临床肝胆病杂志,2022,38(5):1006-1015.
[9] 唐文富,李军祥,陈誩.慢性胰腺炎中西医结合诊疗共识意见(2020)[J].中国中西医结合消化杂志,2020,28(10):731-739.
[10] 邓小明,梁练平.胰腺癌与胰腺炎性肿块的MRI影像特征分析[J].现代诊断与治疗,2022,33(22):3405-3407.
[11] 周欣,杨学燕,胡迎,等.多层螺旋CT与MRI扫描对胰腺癌、慢性胰腺炎的诊断价值研究[J].中国CT和MRI杂志,2022,20(3):94-96.
[12] 董军强,解非,张智翔,等.多层螺旋CT与MRI扫描对胰腺癌和胰腺炎的鉴别诊断[J].实用临床医药杂志,2023,27(9):8-12.
[13] 张杰,李杰,毕卫群,等.CT及MRI多模态参数对鉴别胰头部肿块型慢性胰腺炎与胰头癌的价值[J].医学影像学杂志,2021,31(2):275-279.
[14] 申旭鹏,姜慧杰,李金平.CT和MRI影像技术在胰腺癌与胰腺炎性肿块鉴别诊断中的价值[J].中华全科医师杂志,2020,19(12):1189-1193.
[15] 王宇路,王苏平,赵雪梅,等.磁共振胰胆管成像对肿块型胰腺炎与胰腺癌的诊断价值[J].医学信息,2021,34(13):176-178.
[16] BARTOLI M, BARAT M, DOHAN A, et al.CT and MRI of pancreatic tumors: an update in the era of radiomics[J]. Jpn J Radiol,2020,38(12):1111-1124.