3.0T磁共振多序列成像对鉴别胰头癌与胰头肿块型慢性胰腺炎的应用价值

目的：探讨磁共振多序列成像对鉴别胰头癌与胰头肿块型慢性胰腺炎的临床价值及意义。方法：对已确诊的16例胰头癌患者和5例胰头肿块型慢性胰腺炎患者的磁共振多序列成像MR进行回顾性分析。主要征象包括：①肿块信号及形态学特点；②胰管及胆管扩张情况；③动态增强的特征；④胰周及大血管受累情况；⑤邻近器官受累与淋巴结肿大情况。检查方法包括：平扫T1WI＋FST2WI＋FS，MRCP，3D—VIBE动态增强扫描。结果：1）肿块形态信号异常：胰头癌与胰头肿块型胰头慢性胰腺炎的信号有较多重叠，在TlwI上均表现为相对低信号，T2WI表现为不均匀稍高、相等或低信号。2）胰管与胆管的异常：胰头癌表现为胰管扩张至肿块处突然截断12例，胆总管突然截断10例，“双管征”10例。胰头肿块型慢性胰腺炎胰管扩张3例，2例为串珠样扩张，扩张的胰管可贯通病灶区，胆总管5例均扩张，远端呈短锥形狭窄3例，鼠尾样狭窄2例。3）3D—VIBE强化特征分析结果：随着时间的延长胰头癌强化程度和强化百分率较胰头肿块型慢性胰腺炎明显减低。4）胰周大血管受累情况：胰头癌肿块与血管分界不清者8例，部分包绕血管6例完全包绕血管6例；胰头肿块型慢性胰腺炎1例与血管分界不清，1例部分被包绕。5）邻近器官受累与淋巴结肿大情况：胰头癌有7例淋巴结肿大主要分布在胰周及腹主动脉旁，胰头肿块型慢性胰腺炎，未见明显肿大淋巴结，有四例肾周筋膜增厚，两例肾前筋膜增厚。结论：磁共振多序列成像的联合使用及征象分析，有助于鉴别胰头癌与胰头肿块型慢性胰腺炎。

Application of Multiple Sequence 3.0T MR Imaging on Differentiating Pancreatic Cancer and Chronic Pancreatitis

Objective： To explore the diagnostic value and significance of magnetic resonance imaging on the identification of multiple sequence pancreatic cancer and chronic pancreatitis. Methods： 16 cases with pancreatic cancer and 5 cases with chronic pancreatitis who were confLrmed the pancreatic tumors by magnetic resonance imaging multiple sequence were retrospectively analyzed. Major signs, including the mass signal and morphological characteristics ①tumor signal and morphological characteristics; ② the pancreatic duct and bile duct expansion;③ great vessels; ④ peripancreatic involvement; O adjacent organ involvement with lymphadenopathy situation. The checking method： un-enhanced T1WI＋FS T2WI＋FS, MRCP, 3D-VIBE （three-dimensional gradient-echo volumetric interpolated） dynamic contrast-enhanced scans. Results： 1） Tumor morphology signal abnormalities： there was more overlap about the pancreatic cancer and chronic pancreatitis in terms of the pancreatic head signal performance and the T1WI that have showed relatively low signal, T2WI showed slightly uneven or low signal. 2） Pancreatic and bile duct abnormalities： 12 cases represented the duct dilatation performance to mass at the sudden cut of pancreatic cancer and pancreatic; ten cases of bile duct were suddenly cut off; ten cases showed the ＂double duct sign＂, three cases reflected on the mass in chronic pancreatitis and pancreatic duct dilatation; two cases with beaded expansion, five cases represented that the expansion of pancreatic lesions could penetrate the common bile duct dilatation; three cases were short tapered distal stenosis; two cases were narrow tail-like. 3） 3D-VIBE enhancement feature analysis： with the time passing by, the percentage was higher than before and the degree of enhancement and strength of the pancreatic head mass in chronic pancreatitis were significantly reduced. 4） Peri pancreatic major vascular involvement： eight cases showed the pancreatic cancer tumor and vascular unclear boundaries, six cases reflected on the part of the surrounding blood vessels, six cases were completely enveloped; one case of pancreatic mass represented the chronic pancreatitis and vascular unclear boundaries, one case was partially wrapped. 5）Adjacent organ involvement with lymphadenopathy situations： there are cases of pancreatic cancer, swollen lymph nodes mainly in the peri pancreatic and para-aortic, chronic pancreatitis, pancreatic tumors, and there was no significant enlargement of the lymph nodes, four cases with the peri renal fascia thickening, two cases of pancreatic cancer with renal fascial thickening. Conclusion： It is helpful to diagnose and identify pancreatic cancer, chronic panereatitis and pancreatic tumors by means of the joint use of multiple sequences of magnetic resonance imaging.