| Part 1 Analysis of Pancreatic Cancer by ~1H Magnetic Resonance pectroscopy and Correlation with Tumor DifferentiationObjective: To discuss the metabolites of tumors and peritumoral pancreatic duct intraepithelial neoplasia(Pan IN)tissue in pancreatic cancer by ~1H magnetic resonance spectroscopy(~1H MRS)and correlation with tumor differentiation.Methods: 47 patients(17 with poorly differentiated tumors and 30 with moderately differentiated tumors)with pancreatic duct adenocarcinoma confirmed by histopathology.Before operation,respiration-triggered water suppression point-resolved spectroscopy(PRESS)sequence of ~1H MRS was used for detection of metabolites in tumors and peritumoral Pan IN tissue.To calculate the ratio of choline-containing metabolites(CCM)peak area to lipid(Lip)peak area(CCM/Lip),cholesterol and the unsaturated parts the olenfinic region of fatty acids(Chol+Unsat)peak area to Lip peak area(Chol+Unsat/Lip),Chol+Unsat peak area to CCM peak area(Chol+Unsat/CCM)in every ~1H MRS data.The paired sample t test was used for compare metabolites in tumors and peritumoral Pan IN tissue.The independent sample t test was used for compare metabolites in poorly and moderately differentiated tumors of pancreatic duct adenocarcinoma.Results: 24 patients were measured ~1H MRS data of tumors tissue and peritumoral Pan IN tissue at the same time.The ratio of CCM/Lip in tumors(2.66±0.84)×10-1 were higher than peritumoral Pan IN tissue(2.00±0.81)×10-1.The ratio of Chol+Unsat/Lip in tumors(3.24±1.09)×10-1 were higher than peritumoral Pan IN tissue(2.58±0.92)×10-1.There were statistically significant differences(P<0.05).The ratio of Chol+Unsat/CCM had no statistical difference between tumors tissue and peritumoral Pan IN tissue.The ratio of CCM/Lip,Chol+Unsat/Lip,Chol+Unsat/CCM had no statistical difference between poorly and moderately differentiated tumors of pancreatic duct adenocarcinoma.Conclusions: ~1H MRS has a significance to distinguish tumors tissue and peritumoral Pan IN tissue in pancreatic cancer,but no associations with tumor differentiation.Part 2 Comparison of Imaging Findings of MSCT and Pathological in etastatic Lymph Nodes of Pancreatic CancerObjective: To discuss the MSCT imaging characteristics of metastatic lymph nodes in pancreatic cancer.Methods: The MSCT images of 30 patients(23 men,mean age,60 years;7 women,mean age,66years)confirmed by surgery were analyzed retrospectively.The locations,sizes,shapes,density and the degree of enhancement of the metastatic lymph nodes were analyzed.Results: The number of metastatic lymph nodes was 63 by pathological diagnosis and 53 by MSCT.The metastatic lymph nodes most commonly occurred in group 13 and 17 in pancreatic head cancer and group 18 in pancreatic body and tail cancer.The size of MSAD was 2~17mm(7.23±4.03)mm.All patients were divided into MSAD<5mm group,5mm~<10mm group and ≥10mm group based on the size of lymph nodes.The number of metastatic lymph nodes of the three groups were 10,18 and 25 respectively.There were statistically significant differences in the degree of enhancement,necrosis and fusion tendency in the three groups(P<0.05).Comparison between the two groups,The number of MSAD < 5mm group(7/10)and 5mm~ < 10 mm group(11/18)enhancement metastatic lymph nodes were more than≥10mm group(2/25).The number of MSAD<5mm group(6/10)clear edge metastatic lymph nodes were more than≥10mm group(5/25).The number of MSAD<5mm group(2/10)necrosis metastatic lymph nodes less than≥10mm group(18/25).The number of MSAD<5mm group(0/10)and 5mm~<10mm group(2/18)fusion tendency metastatic lymph nodes were less than≥10mm group(22/25).There were statistically significant differences(P<0.05).Conclusions: The main imaging findings of metastatic lymph nodes were the degree of enhancement,the tendency of internal necrosis and fusion.It is more helpful in the diagnosis of metastatic lymph nodes combined with uneven density and unclear edge.Part 3 Diagnostic of Metastatic Lymph Nodes of Pancreatic Cancer by .0T Magnetic Resonance Diffusion Weighted ImagingObjective: To explore the preoperative diagnostic value of 3.0T MR diffusion weighted imaging(DWI)for metastatic lymph nodes in pancreatic cancer.Methods: Thirty patients with pancreatic cancer who underwent preoperative routine MR DWI examination were enrolled in the study,Metastatic and non-metastatic lymph nodes were confirmed by pathology compared with were treated by pancreatic cancer resection plus lymph node dissection.The locations,apparent diffusion coefficient(ADC)values,maximum short axis diameter(MSAD)of lymph nodes were analyzed.Receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of ADC and MSAD for differentiating metastatic lymph nodes from non-metastatic lymph nodes.Results: The number of lymph nodes was 63 by DWI and pathological diagnosis,54 metastatic lymph nodes and 54 non-metastatic lymph nodes.The metastatic lymph nodes most commonly occurred in group 13,16,17 in pancreatic head cancer and group 16 in pancreatic body and tail cancer.The ADC values of metastatic lymph nodes [(1.51±0.28)×10-3 mm2/s] was lower than non-metastatic lymph nodes [(2.08±0.35)×10-3 mm2/s].The MSAD of metastatic lymph nodes [(7.03±2.49)mm] was longer than nonmetastatic lymph nodes [(4.40±0.97)mm].There were statistically significant differences(P<0.05).The areas under the ROC curve of ADC values and MSAD were 0.894,0.876,respectively.Optimal cutoff values for ADC were 1.78×10-3mm2/s,5.65 mm,respectively,and the corresponding sensitivities and specificities were 85.2% and 68.5%,85.2% and 90.7%.Conclusions: 3.0T MR DWI have a high diagnostic value for metastatic lymph nodes in pancreatic cancer. |
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