CAJ | 학술논문

目的：探讨MRCP、TrueFISP结合3D-VIBE动态增强MR扫描在十二指肠恶性肿瘤诊断中的价值。方法收集资料完整的原发性十二指肠恶性肿瘤29例,回顾性分析 MR 资料,观察病变发生部位、形态、信号特点、周围结构及有无远处转移。结果本组腺癌共21例,黏液腺癌及印戒细胞癌混合1例,印戒细胞癌1例,神经内分泌癌1例,未分化癌1例,恶性间质瘤3例,1例霍奇金氏淋巴瘤。MR 主要表现为十二指肠局部肠壁偏心性或环形不规则增厚,形成软组织结节或肿块,黏膜破坏消失,伴肠腔狭窄,均匀或不均匀持续强化。恶性间质瘤肿瘤较大,合并囊变坏死。淋巴瘤表现为肠壁弥漫增厚,合并腹膜后多发淋巴结肿大。7例侵犯胰头,7例合并淋巴结转移,5例合并肝转移。结论MRCP、TrueFISP 及3D-VIBE 动态增强扫描结合对十二指肠恶性肿瘤诊断具有重要价值。肠壁不规则增厚并肿块形成、黏膜破坏消失是十二指肠恶性肿瘤的重要征象,病灶侵犯周围结构、合并淋巴结肿大或远处转移则有助于定性诊断。
목적：탐토MRCP、TrueFISP결합3D-VIBE동태증강MR소묘재십이지장악성종류진단중적개치。방법수집자료완정적원발성십이지장악성종류29례,회고성분석 MR 자료,관찰병변발생부위、형태、신호특점、주위결구급유무원처전이。결과본조선암공21례,점액선암급인계세포암혼합1례,인계세포암1례,신경내분비암1례,미분화암1례,악성간질류3례,1례곽기금씨림파류。MR 주요표현위십이지장국부장벽편심성혹배형불규칙증후,형성연조직결절혹종괴,점막파배소실,반장강협착,균균혹불균균지속강화。악성간질류종류교대,합병낭변배사。림파류표현위장벽미만증후,합병복막후다발림파결종대。7례침범이두,7례합병림파결전이,5례합병간전이。결론MRCP、TrueFISP 급3D-VIBE 동태증강소묘결합대십이지장악성종류진단구유중요개치。장벽불규칙증후병종괴형성、점막파배소실시십이지장악성종류적중요정상,병조침범주위결구、합병림파결종대혹원처전이칙유조우정성진단。
Objective To discuss the value of MRCP and TrueFISP combined with 3D-VIBE dynamic contrast-enhanced MRI in the diagnosis of malignant duodenal tumor.Methods 29 cases of primary malignant duodenal tumors with integrated data were col-lected,the MR data was retrospectively analysed,the tumors’locations,shapes,signal features,surrounding structures and distant metastases were observed.Results Of the 29 patients,there were,in total,21 adenocarcinomas,1 mucinous adenocarcinoma and sig-net-ring cell mixed carcinoma,1 signet-ring cell carcinoma,1 neuroendocrine carcinoma,1 anaplastic carcinoma,3 malignant gastroin-testinal stromal tumors and 1 Hodgkin lymphoma.Imaging signs were mainly included the following:duodenum wall thickening asymmetrically or symmetrically,accompanied with soft tissue masses or nodi,intestinal mucosa destruction and disappearance with intestinal stenosis,and continued homogeneous or inhomogeneous enhancement.Malignant gastrointestinal stromal tumor exhibited a massive mass,and was more likely to have an area of necrosis or cystic degeneration.Lymphoma showed extensive duodenal wall thickening and retroperitoneal lymph node enlargement.7 cases had pancreatic head invasion;7 cases showed lymphatic metastasis;5 cases had hepatic metastasis.Conclusion MRCP and TrueFISP combined with 3D-VIBE dynamic contrast-enhanced scan have nota-ble diagnostic value in primary malignant duodenal tumors.The signs of duodenum wall thickening along with soft tissue masses and intestinal mucosa destruction could be the most important hint for making diagnosis.The signs of surrounding structure invasion, lymphatic metastasis or distant metastases will help to confirm the diagnosis.