科研进展26

今天为大家介绍发表在Radiology上的一篇文献：

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Evaluation of Malignant Potential and Surgical Resectability by Using MR Imaging with MR Cholangiography 

MRI及MRCP对胰腺导管内乳头状粘液性肿瘤恶性潜能和手术可切除性的评价研究

 ✧Radiology. 2015 Mar;274(3):723-33

Purpose 目的

To evaluate the diagnostic performance of magnetic resonance (MR) imaging with MR cholangiopancreatography (MRCP) in determining the malignant potential and surgical resectability of pancreas intraductal papillary mucinous neoplasms (IPMNs)

评价磁共振成像（MRI）及磁共振胰胆管水成像（MRCP）对胰腺导管内乳头状黏液性肿瘤（IPMNs）恶性潜能和手切可切除性的诊断价值

Materials and Methods 材料与方法

Institutional review board approval was obtained, and the requirement for informed consent was waived. Ninety-eight patients with pathologically proved pancreas IPMNs who underwent MR imaging with MRCP comprised the study population. MR images were analyzed for findings suggestive of high-risk stigmata or worrisome features, as proposed by the international consensus guidelines 2012. Interobserver agreement between two experienced observers (observers 1 and 2) and one inexperienced observer (observer 3) was assessed. Diagnostic performance of MR imaging in the evaluation of the malignant potential and surgical resectability of IPMNs was analyzed in these three observers by using receiver operating curve analysis

本研究共纳入98例经病理证实胰腺IPMNs的患者，每个患者均接受MRI及MRCP检查。依据2012年国际共识提出的标准，分析图像得到对应的高风险征象和潜在恶性征象。观察者间一致性研究通过两名有经验的观察者(观察家1和2)和一个没有经验的观察者(观察者3)进行评估。MRI及MRCP对IPMNs恶性潜能和手术可切除性的诊断效能通过受试者工作曲线（ROC）进行分析

Results 结果

MR imaging with MRCP showed sensitivity of 83% (35/42), 79% (33/42), and 90% (38/42); specificity of 80% (41/51), 51% (26/51), and 24% (12/51); and accuracy of 82% (76/93), 63% (59/93), and 54% (50/93) for observers 1, 2, and 3, respectively, in the evaluation of the malignant potential of pancreas IPMNs when at least one worrisome feature was present. Interobserver agreement in the detection of intramural nodules (κ = 0.349–0.574), enhanced solid components (κ = 0.318–0.574), and measurement of main pancreatic duct diameter (intraclass correlation coefficient = 0.9477) was fair to high. The respective sensitivity, specificity, and accuracy in determination of surgical resectability were 95% (81/85), 99% (84/85), and 88% (75/85); 69% (9/13), 69% (9/13), and 54% (7/13); and 92% (90/98), 95% (93/98), and 84% (82/98) for observers 1, 2, and 3

当存在至少一个可疑恶性征象时，三位观察者（观察者1-3）应用MRI及MRCP评估IPMNs恶性潜能的敏感性分别为83%、79%、90%，特异度分别为80%(41/51)、51%、24%，准确度分别为82%、63%、54%。三位观察者间判断恶性征象的一致性由中等到良好。三位观察者应用MRI及MRCP评估IPMNs手术可切除性的敏感性分别为95%、99%、88%，特异度分别为69%、69%、54%，准确度分别为92%、95%、84%

Conclusion 结论

Conclusion：MR imaging with MRCP is a useful modality in the evaluation of the malignant potential and resectability of IPMNs, with high sensitivity and moderate specificity in the experienced radiologists but relatively low specificity in the inexperienced radiology trainee

MRI联合MRCP可以良好的评价IPMNs的恶性潜能和手术可切除性，经验丰富影像医生的诊断具有高的敏感性和中等的特异度，但缺少训练的实习生的诊断特异度相对较低

点评

作为一种具有恶性潜能的肿瘤，IPMNs的治疗方案和临床预后与肿瘤的恶性程度密切相关。术前准确评估肿瘤的良恶性及手术可切除性能够指导临床制定合适的治疗策略。本篇论文着眼于临床实际工作，探讨了MRI及MRCP对IPMNs的评估价值，显示MRI及MRCP在评价肿瘤恶性程度和手术可切除性方面具有良好的诊断价值。但需要注意的是，本文还提出影像医生的经验水平对肿瘤评估的准确性有一定影响，因此需要影像医生熟悉IPMNs的影像学表现，充分了解对应的肿瘤高风险及潜在恶性征象，以期在临床工作中做出准确的诊断