多层螺旋CT与MRI扫描对胰腺癌和胰腺炎的鉴别诊断

Differential diagnosis of pancreatic cancer and pancreatitis by multi-slice spiral CT and MRI

  • 摘要:
    目的  探讨多层螺旋CT与MRI扫描对胰腺癌和胰腺炎的鉴别诊断价值。
    方法  选择胰腺癌患者45例和胰腺炎患者60例,均给予多层螺旋CT与MRI扫描检测,以病理结果为金标准,比较多层螺旋CT、MRI、多层螺旋CT联合MRI鉴别诊断胰腺癌和胰腺炎的准确率; 比较胰腺癌与胰腺炎在动脉期、胰腺期、门脉期CT值; 比较胰腺癌及胰腺炎影像学特征,包括胰腺体积增大、周围淋巴结肿大、病变侵犯至周围组织及大血管、病变内钙化、病变累及周围囊肿、胰胆管不规则扩张、动脉期强化。
    结果  经病理学检查,胰腺癌患者45例,胰腺炎患者60例; 多层螺旋CT检查显示,胰腺癌34例,诊断准确率为75.56%, 胰腺炎46例, 诊断准确率为76.67%; MRI检查显示,胰腺癌35例,诊断准确率为77.78%, 胰腺炎47例,诊断准确率为78.33%; 多层螺旋CT联合MRI检查显示,胰腺癌44例,诊断准确率为97.78%, 胰腺炎58例,诊断准确率为96.67%。多层螺旋CT联合MRI检查鉴别诊断胰腺癌和胰腺炎准确率高于单一多层螺旋CT、MRI, 差异有统计学意义(P < 0.05); 胰腺癌患者动脉期、胰腺期、门脉期CT值较胰腺炎患者低,差异有统计学意义(P < 0.05); 胰腺癌患者胰腺体积增大、周围淋巴结肿大、病变侵犯至周围组织及大血管发生率分别为73.33%、51.11%、66.67%, 高于胰腺炎患者的26.67%、0%、35.00%, 差异有统计学意义(P < 0.05); 胰腺癌患者病变内钙化、病变累及周围囊肿、胰胆管不规则扩张、动脉期强化发生率分别为33.33%、6.67%、11.11%、24.44%, 低于胰腺炎患者的75.00%、28.33%、45.00%、60.00%, 差异有统计学意义(P < 0.05)。
    结论  多层螺旋CT联合MRI扫描对胰腺癌和胰腺炎的鉴别诊断准确率高于单一多层螺旋CT、MRI检查,胰腺癌和胰腺炎不同扫描期CT值、影像学特征存在差异。

     

    Abstract:
    Objective  To explore the value of multi-slice spiral CT and MRI in differential diagnosis of pancreatic cancer and pancreatitis.
    Methods  A total of 45 patients with pancreatic cancer and 60 patients with pancreatitis were selected. All the patients were conducted with multi-slice spiral CT and MRI scan, and the accuracy rates of multi-slice spiral CT, MRI and multi-slice spiral CT combined with MRI in the differential diagnosis of pancreatic cancer and pancreatitis were compared based on pathological results as the gold standard; CT values of pancreatic cancer and pancreatitis in arterial, pancreatic and portal phases were compared; the imaging features of pancreatic cancer and pancreatitis were compared, including increased pancreatic volume, enlargement of peripheral lymph nodes, invasion of the lesion into the surrounding tissues and large blood vessels, calcification within the lesion, involvement of peripheral cysts, irregular dilatation of the pancreatic and bile ducts, and arterial enhancement.
    Results  Pathological examination showed that there were 45 cases of pancreatic cancer and 60 cases of pancreatitis; the multi-slice spiral CT examination showed that there were 34 cases of pancreatic cancer (the diagnostic accuracy rate was 75.56%) and 46 cases of pancreatitis (the diagnostic accuracy rate was 76.67%); the MRI examination showed that there were 35 cases of pancreatic cancer (the diagnostic accuracy rate was 77.78%) and 47 cases of pancreatitis (the diagnostic accuracy rate was 78.33%); the multi-slice spiral CT combined with MRI showed that there were 44 cases of pancreatic cancer (the diagnostic accuracy was 97.78%) and 58 cases of pancreatitis (the diagnostic accuracy was 96.67%). The accuracy of multi-slice spiral CT combined with MRI in the differential diagnosis of pancreatic cancer and pancreatitis was significantly higher than that of single multi-slice spiral CT and MRI (P < 0.05); CT values at arterial, pancreatic and portal phases in patients with pancreatic cancer were significantly lower than those in patients with pancreatitis (P < 0.05); the incidence rates of pancreatic volume enlargement, peripheral lymph node enlargement, and lesion invasion into peripheral tissues and great blood vessels in patients with pancreatic cancer were 73.33%, 51.11% and 66.67%, which were significantly higher than 26.67%, 0% and 35.00% in patients with pancreatitis (P < 0.05); the incidence rates of the intra-lesion calcification, lesion involvement of peripheral cysts, irregular dilatation of pancreatic bile duct, and arterial enhancement in patients with pancreatic cancer were 33.33%, 6.67%, 11.11% and 24.44% respectively, which were significantly lower than 75.00%, 28.33%, 45.00% and 60.00% in patients with pancreatitis (P < 0.05).
    Conclusion  The accuracy of multi-slice spiral CT combined with MRI in the differential diagnosis of pancreatic cancer and pancreatitis is higher than that of single multi-slice spiral CT and MRI, and there are differences in CT values and imaging characteristics between pancreatic cancer and pancreatitis at different scanning stages.

     

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