摘要
目的探讨磁共振弥散加权成像(DWI)联合三维容积内插值屏气检查(3D-VIBE)在评价肝门胆管癌淋巴结转移中的价值。方法收集2009年7月至2011年3月行上腹部磁共振成像(MRI)检查并经手术、病理学检查证实的连续性肝门胆管癌病例37例,比较DWI和VIBE序列对淋巴结显示的差异,分析淋巴结的形态及分布情况。在DWI序列上测量淋巴结的信号强度(SI)并计算表观弥散系数(ADC),在3D-VIBE图像上测量淋巴结与肝实质SI之比(SI淋巴结/SI肝脏),对转移性与非转移性淋巴结的差异进行比较。结果 37例患者59组淋巴结中,51组在DWI和3D-VIBE序列上均显示,8组仅在一种序列图像上显示,两种序列图像淋巴结显示率的差异无统计学意义(P=0.070)。在DWI轴位像和3D-VIBE增强扫描图像上,所有显示淋巴结的短径分别为(0.82±0.27)cm和(0.79±0.26)cm,两者的差异无统计学意义(P=0.628)。3D-VIBE图像上,转移性淋巴结的短径为(1.05±0.42)cm,明显大于非转移性淋巴结〔(0.78±0.22)cm〕,P=0.030。转移性淋巴结的ADC值为(1.64±0.30)×10-3mm2/s,明显小于非转移性淋巴结的ADC值〔(2.28±0.79)×10-3mm2/s〕,P=0.033。动态增强扫描门静脉期转移性与非转移性淋巴结的SI淋巴结/SI肝脏分别为1.24±0.31和1.33±0.25,3 min延迟期转移性与非转移性淋巴结的SI淋巴结/SI肝脏分别为1.34±0.28和1.19±0.15,差异均无统计学意义(P=0.368,P=0.081)。在DWI序列图像中,随着b值增大,图像的SI逐渐降低。结论 DWI和3D-VIBE序列检测的ADC值及淋巴结短径的差异对于鉴别肝门胆管癌淋巴结转移具有一定价值,联合DWI、3D-VIBE序列能够更准确地评价肝门胆管癌淋巴结转移情况。
Objective To investigate the value of diffusion weighted imaging（DWI） combined with three-dimensional volumetric interpolated breath-hold examination（3D-VIBE） in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.Methods From July 2009 to March 2011,DWI examination was performed in 37 patients with hilar cholangiocarcinoma,which was compared with 3D-VIBE sequences.The morphological characteristics and distribution were analyzed for metastatic and nonmetastatic lymph nodes.Signal intensity（SI） was measured on DWI images and apparent diffusion coefficient（ADC） was calculated for each lymph node.The SI of lymph nodes（SILN） and liver（SIliver） were also measured and the ratio of SI was calculated.The ADC and the ratio of SI were compared between metastatic and nonmetastatic lymph nodes.Results There were fifty-nine groups of lymph nodes in 37 patients with hilar cholangiocarcinoma,fifty-one groups were revealed in both DWI and 3D-VIBE sequences,and eight groups were only demonstrated in one sequence（P=0.070）.The short diameters were（1.05±0.42） cm and（0.78±0.22） cm on 3D-VIBE images for metastatic and nonmetastatic lymph nodes,respectively（P=0.030）.The ADC value in metastatic lymph nodes was（1.64±0.3）×10^3 mm^2/s,which was significantly lower than that in nonmetastatic lymph nodes（（2.28±0.79）×10^-3 mm^2/s） on DWI images（P=0.033）.There were no significant differences in SILN/SIliver between metastatic and nonmetastatic lymph nodes on images of portal venous phase and 3 min delayed contrast-enhanced phase.Conclusions Differences of ADC and short diameter can provide valuable information to differentiate metastatic lymph nodes with nonmetastatic lymph nodes.When combined with 3D-VIBE sequence,DWI is more effective in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.
出处
《中国普外基础与临床杂志》
CAS
2011年第7期773-778,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川省科技支撑项目(项目编号:2010SZ0074)~~
关键词
磁共振成像
弥散加权成像
三维容积内插值屏气检查
肝门胆管癌
淋巴结转移
Magnetic resonance imaging
Diffusion weighted imaging
Threedimensional volumetric interpolated breath-hold examination
Hilarcholangiocarcinoma
Lymph node metastasis
