作　　者： (金开璞）; (盛若凡）; (饶圣祥）; (丁莺）; (戴亚婕）; (曾蒙苏）;

机构地区： 复旦大学附属中山医院放射科上海市影像医学研究所,200032

出　　处： 《中华放射学杂志》 2017年第8期592-596,共5页

摘　　要： 目的 探讨采用MRI评价胆管内乳头状瘤（IPNB）侵袭性的价值.方法 回顾性分析行根治术完整切除病灶,经病理诊断为IPNB,且术前6周内在本院进行过上腹部MRI检查的39例IPNB患者.根据病理结果将患者分为非侵袭组和侵袭组,非侵袭组18例,侵袭组21例.患者均行上腹部MRI平扫胰胆管成像和动脉期、门静脉期、延迟期增强扫描.在MRI图像上观察肿瘤最大径、肿瘤位置、受累胆管扩张程度、是否存在条纹征、病灶形态及是否存在肝叶萎缩、胆管结石、出血、侵犯大血管、肝门或腹腔淋巴结肿大等,测量病灶ADC值,计算病灶增强后强化率.采用t检验或Mann-Whitney U检验比较非侵袭组和侵袭组间临床指标（包括血清CA199）、病灶强化率、对比噪声比（CNR）及ADC值的差异,采用χ2检验比较两组间病变部位、形态、周围结构侵犯等分类变量间的差异,采用ROC分析MRI指标诊断IPNB侵袭性的效能.结果 非侵袭与侵袭组患者的性别、年龄、病灶形态、胆管直径、病灶位置、出现条纹征和结石差异无统计学意义（P＞0.05）;血清CA199、病灶最大径、ADC值、淋巴结和血管受累的差异有统计学意义（P＜0.05）.除平扫侵袭组和非侵袭组CNR差异无统计学意义外（P＞0.05）,动脉期、门静脉期和延迟期2组患者的CNR差异均有统计学意义,各期的强化率差异也均有统计学意义（P＜0.05）.CA199、门静脉期强化率、门静脉期CNR、ADC值诊断IPNB侵袭性的ROC下面积分别为0.790、0.891、0.817和0.882.结论 采用MRI评价IPNB的侵袭性具有较高的价值. Objective To value the capability of MRI in assessing invasiveness of intraductal papillary neoplasms of the bile duct（IPNB）. Methods Thirty-nine patients with pathologically confirmed IPNB, who had upper abdominal MR examination within 6 weeks before complete resection of the tumor, were included in the retrospective study. Patients were divided into noninvasive and invasive groups pathologically. Eighteen cases were noninvasive and 21 were invasive. All had undergone MRI plain scans, MR cholangiopancreatography as well as contrast enhanced scans including arterial, portal and delayed phases. Tumor size, location, biliary dilation, thread signs, lesion morphology, lobe atrophy, cholelithiasis, biliary hemorrhage, vascular invasion and intraperitoneal lymphadenopathy were observed on MRI. ADC values and enhancement level of lesions were also measured. Between invasive and noninvasive groups, laboratory results, enhancement levels and ADC values were compared by t test or Mann-Whitney U test, and categorical variables like location and lesion morphology were compared by χ2 test. The diagnostic accuracy was calculated using receiver operating characteristic（ROC）curve analysis. Results No difference was found between invasive and noninvasive groups on gender, age, lesion morphology, bile duct diameter, location, existence of thread signs or cholelithiasis（P〉0.05）. While the differences on serum CA19-9 level, lesion size, ADC value, and lymph nodes/vascular invasion between groups reached statistical significance （P〈0.05）. Other than on plain scan（P〉0.05）, CNR and enhancement levels were also statistically different on arterial, portal and delayed phases between both groups（P〈0.05）. CA199, enhancement level and CNR of portal phase, as well as ADC value exhibited areas under the ROC curve（AUC）of 0.790, 0.891, 0.817 and 0.882 respectively in invasiveness judgment. Conclusion MR demonstrated relatively high value in assessing invasiveness of IPNB.

关 键 词： 胆管肿瘤 磁共振成像 对比研究