摘要
目的：淋巴结转移是胰腺癌主要的转移方式，影响手术治疗疗效和预后，本研究旨在评估3.0T磁共振扩散加权成像（DWI）在判断胰腺癌转移性淋巴结方面的准确性及临床应用价值。方法：选择本院2012年12月—2013年11月39例胰腺癌伴胰周淋巴结肿大的患者，行常规MR加DWI检查，手术行胰腺癌根治术并行区域性淋巴结清扫，对照术后病理结果，确定转移性和反应增生性淋巴结，测量淋巴结的表观弥散系数（ADC）值及短径，并绘制受试者工作特征（ROC）曲线评估淋巴结ADC值及短径对转移性淋巴结的鉴别诊断价值。结果：39例胰腺癌患者共获取部位明确的淋巴结65枚，其中转移性淋巴结28枚，反应增生性淋巴结37枚。转移性淋巴结在DWI上呈明显高信号，反应增生性淋巴结呈等或高信号；其ADC值分别为（1.55±0.21）×10-3 mm2/s和（1.84±0.20）×10-3 mm2/s，短径分别为（12.85±2.78） mm和（10.13±1.85） mm，两者比较差异均有统计学意义（P＜0.05）。ADC值判断淋巴结是否转移的ROC曲线下面积为0.857，取最佳分界值为1.68×10-3 mm2/s。敏感性和特异性分别为81.1％和77.8％。结论：3.0T MR-DWI有利于胰腺癌患者转移性淋巴结的检出，具有一定临床应用价值，ADC值诊断胰腺癌转移性淋巴结的准确度高于短径。
Abstract
Objective: To evaluate the diagnostic value of diffusion-weighted MR imaging(DWI) for differentiating metastatic and hyperplastic lymph nodes(LNs) in patients with pancreatic cancer. Methods: Thirty-nine untreated patients with pancreatic cancer underwent MRI and DWI before surgery. Pancreatectomy with regional lymphadenectomy for pancreatic cancer was then performed in all patients. Of the 65 total dissected and histopathologically evaluated abdominal LNs, the mean ADC values of all enlarged LNs and short-axis diameter of LNs were measured and compared respectively between the metastatic and hyperplastic node group. A receiver operating characteristic(ROC) curve was generated to evaluate the capability of short-axis diameter and ADC measurements in distinguishing metastatic LNs from hyperplastic LNs. Results: The median ADC value (1.55±0.21)×10-3 mm2/s of metastatic nodes was significantly lower than that of the benign group (1.84±0.20)×10-3 mm2/s(P<0.05). DWI showed greater diagnostic accuracy in determining metastatic nodes than the short-axis diameter. Adopting a threshold value(1.68×10-3 mm2/s) of DWI resulted in 81.1% sensitivity, 77.8% specificity in the identification of metastasis in this series of LNs. Conclusion: DWI may provide great potential in effective discrimination of metastatic LNs in pancreatic adenocarcinoma.
关键词
胰腺肿瘤 /
肿瘤转移 /
磁共振成像
Key words
Pancreatic neoplasms /
Neoplasms metastasis /
Magnetic resonance imaging
王悦人;高 军;郭启勇.
3.0T MR-DWI胰腺癌淋巴结转移的诊断价值[J]. 中国临床医学影像杂志. 2014, 25(6): 409-412
WANG Yue-ren;GAO Jun;GUO Qi-yong.
Diagnostic value of 3.0T diffusion-weighted magnetic resonance imaging for detectingmetastatic lymph nodes in pancreatic adenocarcinoma[J]. Journal of China Clinic Medical Imaging. 2014, 25(6): 409-412
中图分类号：
Ｒ735.9
Ｒ73-37
Ｒ445.2
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