Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Qionghui ¹ , ZHANG Xiaoming ¹ , ZENG Nanlin ¹ , LEI Junyang ² , JIAN Su. ¹

Department of Radiology, Affiliated Hospital of North Sichuan Medical College，Nanchong 637000， China;

Corresponding author：

Keywords：

Pancreatic carcinoma; MRI; Diagnosis; Resectability

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ObjectiveTo study the value of Gd-DTPA three dimension fast spoiled gradientecho (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma.MethodsThirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted（GRE T1W） with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. ResultsOf 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8%(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%（21/24）, 87.0%（20/23）, 80.0%（12/15）, 88.9%（8/9） and 83.3%（5/6） respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twentythree cases were confirmed nonresectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%，95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology （κ=0.83）.ConclusionUsing of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.

Citation： ZHAO Qionghui,ZHANG Xiaoming,ZENG Nanlin,LEI Junyang,JIAN Su.. Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2005, 12(3): 301-306. doi: Copy

1.	张群华，倪泉兴. 胰腺癌2 340例临床病例分析 [Ｊ]. 中华医学杂志, 2004; 84（3）∶214.
2.	吴建新，王兴鹏，徐家裕. 胰腺癌流行病学的研究现状 [Ｊ]. 临床内科杂志, 2000； 17（3）∶189.
3.	Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3)∶492.
4.	Fischer U, Vosshenrich R, Horstmann O, et al. Preoperative local MRIstaging of patients with a suspected pancreatic mass [Ｊ]. Eur Radiol, 2002; 12(2)∶296.
5.	Obuz F, Dicle O, Coker A, et al. Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging [Ｊ]. Eur J Radiol, 2001; 38(2)∶146.
6.	Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrastenhanced MR imaging and dualphase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis [Ｊ]. AJR Am J Roentgenol, 1999; 173(3)∶583.
7.	张小明. 胰腺癌： MRI检查技术和诊断 [Ｊ]. 中国医学计算机成像杂志, 2002； 4（6）∶249.
8.	曾荣苏，严福华，周康荣，等. 磁共振动态增强和脂肪抑制技术在胰腺癌诊断中的价值 [Ｊ]. 临床放射学杂志, 2000; 19(11)∶703.
9.	Zeng MS,Yan FH,Zhou KR,et al. MR dynamic Gadoliniumenhanced fast multiplanar spoiled gradientecho and spinecho T1weighted fatsuppressed techniques in diagnosis of pancreatic carcinoma [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(2)∶294.
10.	Ishiguchi T, Ota T, Naganawa S, et al. CT and MR imaging of pancreatic cancer [Ｊ]. Hepatogastroenterology, 2001; 48(40)∶923.
11.	Ichikawa T, Haradome H, Hachiya J, et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging [Ｊ]. Radiology, 1997; 202(3)∶655.
12.	Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging [Ｊ]. Radiology, 1999; 212(1)∶213.
13.	Gabata T, Matsui O, Kadoya M, et al. Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement [Ｊ]. Radiology, 1994; 193(3)∶683.
14.	许亮. 慢性胰腺炎与胰腺癌之动态MRI比较 [Ｊ]. 国外医学临床放射学分册, 2000； 23(3)∶179.
15.	Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: assessment with thinsection helical CT versus with breathhold fast MR imaging——ROC analysis [Ｊ]. Radiology, 1999; 212(2)∶445.
16.	Helmreich F, Schniewind B, Biederer J, et al. The role of magnetic resonance imaging in the preoperative evaluation of the peripancreatic vasculature in pancreas carcinoma [Ｊ]. Rofo, 2004; 176(2)∶239.
17.	Fayad LM, Mitchell DG. Magnetic resonance imaging of pancreatic adenocarcinoma [Ｊ]. Int J Gastrointest Cancer, 2001; 30(1-2)∶19.
18.	Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [Ｊ]. Radiology, 2002; 224(1)∶34.
19.	Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors [Ｊ]. Ann Surg, 1997; 226(4)∶393.
20.	Catalano C, Pavone P, Laghi A, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability [Ｊ]. Eur Radiol, 1998; 8(3)∶428.
21.	龚静山，周康荣. MR动态增强扫描对胰腺癌的应用价值 [Ｊ]. 国外医学临床放射学分册, 2001; 24(5)∶269.

1. 张群华，倪泉兴. 胰腺癌2 340例临床病例分析 [Ｊ]. 中华医学杂志, 2004; 84（3）∶214.
2. 吴建新，王兴鹏，徐家裕. 胰腺癌流行病学的研究现状 [Ｊ]. 临床内科杂志, 2000； 17（3）∶189.
3. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3)∶492.
4. Fischer U, Vosshenrich R, Horstmann O, et al. Preoperative local MRIstaging of patients with a suspected pancreatic mass [Ｊ]. Eur Radiol, 2002; 12(2)∶296.
5. Obuz F, Dicle O, Coker A, et al. Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging [Ｊ]. Eur J Radiol, 2001; 38(2)∶146.
6. Sheridan MB, Ward J, Guthrie JA, et al. Dynamic contrastenhanced MR imaging and dualphase helical CT in the preoperative assessment of suspected pancreatic cancer: a comparative study with receiver operating characteristic analysis [Ｊ]. AJR Am J Roentgenol, 1999; 173(3)∶583.
7. 张小明. 胰腺癌： MRI检查技术和诊断 [Ｊ]. 中国医学计算机成像杂志, 2002； 4（6）∶249.
8. 曾荣苏，严福华，周康荣，等. 磁共振动态增强和脂肪抑制技术在胰腺癌诊断中的价值 [Ｊ]. 临床放射学杂志, 2000; 19(11)∶703.
9. Zeng MS,Yan FH,Zhou KR,et al. MR dynamic Gadoliniumenhanced fast multiplanar spoiled gradientecho and spinecho T1weighted fatsuppressed techniques in diagnosis of pancreatic carcinoma [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(2)∶294.
10. Ishiguchi T, Ota T, Naganawa S, et al. CT and MR imaging of pancreatic cancer [Ｊ]. Hepatogastroenterology, 2001; 48(40)∶923.
11. Ichikawa T, Haradome H, Hachiya J, et al. Pancreatic ductal adenocarcinoma: preoperative assessment with helical CT versus dynamic MR imaging [Ｊ]. Radiology, 1997; 202(3)∶655.
12. Johnson PT, Outwater EK. Pancreatic carcinoma versus chronic pancreatitis: dynamic MR imaging [Ｊ]. Radiology, 1999; 212(1)∶213.
13. Gabata T, Matsui O, Kadoya M, et al. Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement [Ｊ]. Radiology, 1994; 193(3)∶683.
14. 许亮. 慢性胰腺炎与胰腺癌之动态MRI比较 [Ｊ]. 国外医学临床放射学分册, 2000； 23(3)∶179.
15. Nishiharu T, Yamashita Y, Abe Y, et al. Local extension of pancreatic carcinoma: assessment with thinsection helical CT versus with breathhold fast MR imaging——ROC analysis [Ｊ]. Radiology, 1999; 212(2)∶445.
16. Helmreich F, Schniewind B, Biederer J, et al. The role of magnetic resonance imaging in the preoperative evaluation of the peripancreatic vasculature in pancreas carcinoma [Ｊ]. Rofo, 2004; 176(2)∶239.
17. Fayad LM, Mitchell DG. Magnetic resonance imaging of pancreatic adenocarcinoma [Ｊ]. Int J Gastrointest Cancer, 2001; 30(1-2)∶19.
18. Lopez Hanninen E, Amthauer H, Hosten N, et al. Prospective evaluation of pancreatic tumors: accuracy of MR imaging with MR cholangiopancreatography and MR angiography [Ｊ]. Radiology, 2002; 224(1)∶34.
19. Trede M, Rumstadt B, Wendl K, et al. Ultrafast magnetic resonance imaging improves the staging of pancreatic tumors [Ｊ]. Ann Surg, 1997; 226(4)∶393.
20. Catalano C, Pavone P, Laghi A, et al. Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability [Ｊ]. Eur Radiol, 1998; 8(3)∶428.
21. 龚静山，周康荣. MR动态增强扫描对胰腺癌的应用价值 [Ｊ]. 国外医学临床放射学分册, 2001; 24(5)∶269.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging

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