ObjectiveTo study the value of Gd-DTPA three dimension fast spoiled gradientecho (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma.MethodsThirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted（GRE T1W） with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. ResultsOf 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8%(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%（21/24）, 87.0%（20/23）, 80.0%（12/15）, 88.9%（8/9） and 83.3%（5/6） respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twentythree cases were confirmed nonresectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%，95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology （κ=0.83）.ConclusionUsing of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.
目的 探讨螺旋CT双期薄层增强扫描对胰头癌可切除性的评估价值。方法 回顾性分析24例经螺旋CT双期薄层增强扫描胰头癌的CT表现，观察肿块对邻近器官或组织侵犯情况，以及有无远处器官和淋巴结转移，据此判断肿块能否切除，并将其结果与手术病理结果相对照。结果 螺旋CT判断胰头癌可切除的敏感性为90.9%，特异性为84.6%，阳性预测值为83.3%，阴性预测值为91.7%，准确性为87.5%。结论 螺旋CT双期薄层增强扫描判断胰头癌可切除性的价值较高，对外科医生选择最佳治疗方案有较大的帮助。