摘要目的 分析评价3.0 TMR不同DWI序列对胰腺癌诊断中的作用.方法 经病理证实的30例胰腺癌患者,男17例、女13例,年龄39～72岁,平均(58±15)岁.术前在3.0TMR上行基于自旋回波-回波平面成像(SE-EPI)及b值为0和600 s/mm2的DWI序列,包括X、Y、Z轴扩散梯度憋气DWI(BH600ALL)、Z轴扩散梯度憋气DWI (BH600SI)、呼吸门控DWI (TRIG600ALL)、呼吸门控反转恢复脂肪抑制DWI(TRIG600ALL+ FS)及自由呼吸反转恢复脂肪抑制DWI(FB600ALL+ FS).统计学分析各序列图像胰腺癌的对比噪声比(contrast noise ratio,CNR)和对比度(contrast,C),以及胰腺癌、邻近正常胰腺和远端炎症区的ADC值,数据呈正态分布及方差齐性时用单因素方差分析和LSD检验,方差不齐时进行数据转换或者非参数检验.结果 胰腺癌在5个DWI序列中的对比噪声比(F=11.444,P＜0.001)及对比度(F =5.447,P＜0.05)差异有显著统计学意义,TRIG600ALL与TRIG600ALL+ FS中胰腺癌的对比噪声比最高(分别为16.45±10.37和13.38±9.10),TRIG600ALL+FS上胰腺癌的对比度最高(0.39±0.15).胰腺癌在5个DWI序列中的ADC值差异无统计学意义(x2 =7.910,P＞0.05).BH600ALL和BH600SI的胰腺癌、邻近胰腺及远端炎症ADC值差异无统计学意义(F值分别为2.327及0.626,P值均＞0.05),而TRIG600ALL、TRIG600ALL+ FS和FB600ALL+FS显示的胰腺癌、邻近胰腺及远端炎症ADC值差异有统计学意义(F值分别为5.353、15.976及14.556,P值均＜0.05)；其中胰腺癌的ADC值统计学上均低于邻近胰腺及远端炎症(P值均＜0.05).结论 TRIG600ALL+ FS中胰腺癌的对比度及对比噪声比高于其他序列,测量的ADC值也能够更好地反映胰腺癌、邻近胰腺及远端炎症的组织病理状态.在临床上有助于胰腺癌的筛查与诊断.

abstractsObjective To investigate the diagnostic value of different DWI sequences for pancreatic cancer on a 3.0 T MR scanner.Methods Different DWI acquisitions based on SE-EPI sequence were preoperatively performed in 30 patients with pancreatic cancer proven by histopathology on a 3.0 T MR scanner.The patients included 17 males and 13 females.Their age ranged from 39 to 72 years with mean of (57.6 ± 14.9) years.The b values were 0 and 600 s/mm2 and the following sequences were included:breath-hold DWI with MPG pulses in X,Y,Z direction (BH600ALL),breath-hold DWI with MPG pulses in Z direction(BH600SI),respiratory-triggered DWI with MPG pulses in X,Y,Z direction (TRIG600ALL),respiratory-triggered DWI with MPG pulses in X,Y,Z direction and inversion recovery for fat saturation (TRIG600ALL+FS) and free-breathing DWI with MPG pulses in X,Y,Z direction and inversion recovery for fat saturation (FB600ALL+ FS).C,CNR and ADC of pancreatic cancer were caculated and compared among different DWI sequences by statistic mathed.Results CNR (F =11.444,P ＜ 0.001) and C (F =5.447,P ＜ 0.05) of pancreatic cancer displayed noticeably statistical difference among BH600ALL、BH600SI、TRIG600ALL、TRIG600ALL + FS and FB600ALL + FS DWI sequences by ANOVA.Among those five different DWI sequences,the highest CRN of pancreatic cancer was observed in TRIG600ALL and TRIG600ALL + FS(the values were 16.45 ± 10.37 and 13.38 ± 9.10 respectively),while the highest C of pancreatic cancer was noticed in TRIG600ALL + FS (0.39 ±0.15).ADC of pancreatic cancer had no statistical difference among BH600ALL,BH600SI,TRIG600ALL,TRIG600ALL + FS and FB600ALL + FS DWI sequences by Kruskal-Wallis test.For BH600ALL and BH600SI,there were no statistical difference among ADC of pancreatic cancer,adjacent pancreatic tissue and distal pancreatitis by ANOVA.While for all TRIG600ALL,TRIG600ALL + FS and FB600ALL + FS,there were statistical difference among ADC of pancreatic cancer,adjacent pancreatic tissue and distal pancreatitis by ANOVA (F values were 5.353,15.976 and 14.556 respectively,P ＜ 0.05).ADC of pancreatic cancer was statistically lower than that of adjacent pancreatic tissue and distal pancrcatitis on all TRIG600ALL,TRIG600ALL + FS and FB600ALL +FS (P ＜ 0.05).Conelusion Compared to other four DWI sequences,TRIG600ALL + FS had higher C and CNR in pancreatic cancer,and measurement of ADC value was helpful to disclose the histopathological state in pancreatic cancer,adjacent pancreatic tissue and distal pancreatitis.