CAJ | 학술논문

目的分析在体和离体胰头癌磁共振成像(MRI)的信号特征,研究其与大体标本及组织病理特征的相关性.方法 16例胰头癌患者行MRI检查(包括2D FLASH T1WI平扫、动态增强和抑脂TSE T2WI序列扫描),行Whipple手术切除肿瘤.新鲜手术标本再行MRI检查,扫描结束后,即将肿瘤标本按MRI检查方向完整切开,制成连续切片,分析MRI表现与大体切片和组织病理的对应关系.结果肿瘤大小1.5 cm×2.0 cm～4.8 cm×4.2 cm,平均3.6 cm×3.1 cm.在体MRI检查:T1WI序列上,14例肿瘤呈低信号,2例呈等信号;抑脂TSE T2WI序列上,3例肿瘤呈等信号,13例肿瘤呈混杂信号;胰腺实质期增强扫描,15例强化不明显呈低信号,其中11例肿瘤周围呈环形强化;肝脏期增强扫描,9例呈不规则中等强化;增强延迟期,4例延迟强化呈等或略高信号.离体MRI检查: T1WI序列上,16例肿瘤均为低信号;在抑脂TSE T2WI序列中,均为混杂信号.MRI表现和病理的相关性:各类肿瘤成分在T1WI序列上均可为低信号,等信号区以肿瘤组织及炎性细胞为主;T2WI序列上,等低信号以纤维成分为主,略高信号以肿瘤组织和慢性炎症为主,高信号为黏液变性和受压扩张的胰腺导管.增强胰腺期环形强化是多种病理成分共同作用的结果,无明显强化区为肿瘤组织及纤维组织.肝脏期和延迟期强化以纤维成分为主.结论胰头癌肿瘤内由多种病理成分按不同比例混合而成,MRI可揭示胰头癌的病理特征.在可切除的胰头癌肿瘤内,未见明显出血坏死的病理改变.
목적 분석재체화리체이두암자공진성상(MRI)적신호특정,연구기여대체표본급조직병리특정적상관성.방법 16례이두암환자행MRI검사(포괄2D FLASH T1WI평소、동태증강화억지TSE T2WI서렬소묘),행Whipple수술절제종류.신선수술표본재행MRI검사,소묘결속후,즉장종류표본안MRI검사방향완정절개,제성련속절편,분석MRI표현여대체절편화조직병리적대응관계.결과 종류대소1.5 cm×2.0 cm～4.8 cm×4.2 cm,평균3.6 cm×3.1 cm.재체MRI검사:T1WI서렬상,14례종류정저신호,2례정등신호;억지TSE T2WI서렬상,3례종류정등신호,13례종류정혼잡신호;이선실질기증강소묘,15례강화불명현정저신호,기중11례종류주위정배형강화;간장기증강소묘,9례정불규칙중등강화;증강연지기,4례연지강화정등혹략고신호.리체MRI검사: T1WI서렬상,16례종류균위저신호;재억지TSE T2WI서렬중,균위혼잡신호.MRI표현화병리적상관성:각류종류성분재T1WI서렬상균가위저신호,등신호구이종류조직급염성세포위주;T2WI서렬상,등저신호이섬유성분위주,략고신호이종류조직화만성염증위주,고신호위점액변성화수압확장적이선도관.증강이선기배형강화시다충병리성분공동작용적결과,무명현강화구위종류조직급섬유조직.간장기화연지기강화이섬유성분위주.결론 이두암종류내유다충병리성분안불동비례혼합이성,MRI가게시이두암적병리특정.재가절제적이두암종류내,미견명현출혈배사적병리개변.
Objective To prospectively analyze the correlation of MRI image characteristics with histopathological findings in pancreatic head carcinoma in vivo and ex vivo. Methods Sixteen patients with pancreatic head carcinoma were examined by 1.5T MRI. MR sequences included pre- and post-contrast dynamic 2D FLASH T1WI, TSE T2WI + fat suppressed (FS). All fresh specimens were scanned again within an hour after resection during the Whipple procedure, and were then cut into slices along the direction of MRI scan. The MRI image characteristics were compared with gross and histopathologic findings of the specimens. Results The tumor size ranged from 1.5 cm×2.0 cm to 4.8 cm×4.2 cm with a mean value of 3.6 cm×3.1 cm. The MRI findings in vivo showed hypointensity in 14 lesions and isointensity in 2, and on 2D FLASH T1WI and TSE T2WI, all lesions displayed mixed intensity except 3 lesions with iso-intensity. During post-contrast dynamic pancreatic parenchymal phase, 15 lesions showed mild enhancement and 11 lesions had ring enhancement sign. Nine lesions displayed progressive irregular moderate enhancement during post-contrast dynamic hepatic phase. Four lesions showed enhancement with iso- and hyperintensity in post-contrast dynamic delayed phase. The MRI findings demonstrated that all lesions ex vivo had hypointensity on 2D FLASH T1WI and mixed intensity on TSE T2WI + FS. Tumor tissues mainly displayed hypointensity, and the area containing tumor and inflammatory tissue showed iso-intensity on 2D FLASH T1WI. On T2WI + FS, the fibrosis proportion displayed hypo or isointensity, while the tumor and chronic inflammatory tissue demonstrated slight hyperintensity, and the zones of mucous degeneration or pancreatic ductal dilatation displayed hyper-intensity. The ring enhancement of tumor was caused by multiple factors and no obvious enhancement within tumor and fibrosis area were observed during post-contrast dynamic pancreatic parenchymal phase. Progressive irregular enhancement originated from desmoplastic reaction within the tumor during post-contrast dynamic hepatic phase and delayed phase, respectively. Conclusion Pancreatic head carcinomas contain various kinds of tissues. MRI can reveal these pathologic characteristics. No obvious hemorrhage and necrosis within the tumor were observed in this series.