CAJ | 학술논문

目的：探讨MR DWI在自身免疫性胰腺炎（ AIP）鉴别诊断及疗效评估中的价值。方法回顾性分析26例AIP、29例胰腺癌（PC）及30例胰腺正常（NP）患者的DWI资料。观察病灶的分布类型及信号特点，测量病灶或组织的ADC值。 AIP与PC组患者病灶分布类型及信号特点的比较采用χ2检验。各组病灶或组织ADC值的比较采用秩和检验。对AIP组及PC组病灶的ADC值行ROC曲线分析，确定诊断最佳阈值及诊断效能。15例AIP患者行类固醇激素治疗，测量激素治疗前后病灶的ADC值，并采用配对t检验进行比较。结果 AIP组26例中，21例病灶呈弥漫型分布，5例呈局限型分布。 PC组29例中，3例病灶呈弥漫型分布，26例呈局限型分布，病灶分布差异有统计学意义（χ2＝27.64，P＜0.01）。 AIP病灶在DWI上有19例呈高信号，7例呈等信号。 PC病灶24例呈高信号，5例呈等信号，信号强度差异无统计学意义（χ2＝0.75，P＞0.05）。 AIP、PC和NP患者的胰腺病灶或组织的ADC值中位数分别为1.15×10-3、1.35×10-3、1.59×10-3 mm2/s，差异有统计学意义（ H＝45.60，P＜0.01）。 AIP与PC鉴别诊断的ADC最佳阈值为1.255×10-3 mm2/s，诊断AIP的敏感度和特异度分别为80.8％（21/26）和79.3％（23/29），曲线下面积为0.871。15例AIP组患者类固醇激素治疗前、后的ADC值分别为（1.10±0.19）×10-3和（1.57±0.12）×10-3 mm2/s，差异有统计学意义（t＝-10.14，P＜0.01）。结论 DWI在AIP鉴别诊断及疗效评估中有一定价值。 AIP病灶ADC值低于胰腺癌和正常胰腺组织，经类固醇激素治疗后ADC值升高。
목적：탐토MR DWI재자신면역성이선염（ AIP）감별진단급료효평고중적개치。방법회고성분석26례AIP、29례이선암（PC）급30례이선정상（NP）환자적DWI자료。관찰병조적분포류형급신호특점，측량병조혹조직적ADC치。 AIP여PC조환자병조분포류형급신호특점적비교채용χ2검험。각조병조혹조직ADC치적비교채용질화검험。대AIP조급PC조병조적ADC치행ROC곡선분석，학정진단최가역치급진단효능。15례AIP환자행류고순격소치료，측량격소치료전후병조적ADC치，병채용배대t검험진행비교。결과 AIP조26례중，21례병조정미만형분포，5례정국한형분포。 PC조29례중，3례병조정미만형분포，26례정국한형분포，병조분포차이유통계학의의（χ2＝27.64，P＜0.01）。 AIP병조재DWI상유19례정고신호，7례정등신호。 PC병조24례정고신호，5례정등신호，신호강도차이무통계학의의（χ2＝0.75，P＞0.05）。 AIP、PC화NP환자적이선병조혹조직적ADC치중위수분별위1.15×10-3、1.35×10-3、1.59×10-3 mm2/s，차이유통계학의의（ H＝45.60，P＜0.01）。 AIP여PC감별진단적ADC최가역치위1.255×10-3 mm2/s，진단AIP적민감도화특이도분별위80.8％（21/26）화79.3％（23/29），곡선하면적위0.871。15례AIP조환자류고순격소치료전、후적ADC치분별위（1.10±0.19）×10-3화（1.57±0.12）×10-3 mm2/s，차이유통계학의의（t＝-10.14，P＜0.01）。결론 DWI재AIP감별진단급료효평고중유일정개치。 AIP병조ADC치저우이선암화정상이선조직，경류고순격소치료후ADC치승고。
Objective To investigate the role of DWI in differentiating autoimmune pancreatitis ( AIP) from pancreatic cancer ( PC) , and in the therapeutic effect evaluation of AIP.Methods DWI data of 26 cases with AIP , 29 cases with PC and 30 cases with normal pancreas ( NP ) were analyzed retrospectively.The distribution type and signal feature of lesions in cases with AIP or PC were evaluated by Chi-squared test.ADC values were measured and compared among 3 groups by Kruskal-Wallis test.ADC values of AIP and PC were analyzed by using ROC curve to determine the optimal threshold and diagnostic efficiency.ADC values were compared in AIP ( n=15 ) before and after steroid therapy by paired t test.Results Diffuse lesions were detected in 21 cases with AIP and 3 cases with PC, while focal lesions in 5 cases with AIP and 26 cases with PC (χ2 =27.64, P<0.01).On DWI, most of AIP (n=19) and PC (n=24) showed hyper-intense signal, while a few of AIP (n=7) and PC (n =5) showed iso-intense signal (χ2 =0.75, P>0.05).The median ADC values of AIP, PC and NP were 1.15 ×10 -3,1.35 × 10 -3 ,1.59 ×10-3 mm2/s, respectively; and the difference was statistically significant ( H=45.60, P <0.01).ROC analysis yielded an optimal ADC cutoff value of 1.255 ×10 -3 mm2/s (80.8% sensitivity, 79.3%specificity and 0.871 area under curve for the diagnosis of AIP ).ADC values of AIP ( n=15) were markedly increased from the baseline (1.10 ±0.19) ×10 -3 to (1.57 ±0.12) ×10 -3 mm2/s after steroid therapy (t=-10.14, P<0.01).Conclusions DWI may be useful for diagnosing and evaluating the effect of steroid therapy in AIP.ADC values of AIP were significantly lower than those of pancreatic cancer and normal pancreas.After steroid therapy , ADC values were markedly increased in AIP.