| Objective：1. To compare the diagnostic efficiency among multiphasic contrast-enhancedmulti-detector CT, conventional MRI scan and conventional combined functional MRIscan in the pancreatic mass lesions.2. To study the diagnostic value of functional MRI quantitative analysis in pancreaticcancer at3.0T.3. To investigate the correlations among ADC, Ktrans, veand fibrosis, FAP score inpancreatic cancer.Methods：1.42patients with pathologically proved pancreatic masses were performedmultiphasic contrast-enhanced MDCT, conventional MRI and functional MRI scans.Compared with golden standard (pathological results), CT and MRI findings of these42cases were analysed by two observers, respectively. Comparative analysis of sensitivity,specificity, positive predictive value, negative predictive value and their95%confidences interval of three methods between two observers were performed by2×R crosscontingency table chi-square tests. Statistical significance was inferred at P<0.05.2.38patients with clinical or pathological confirmed pancreatic cancer wereperformed conventional MR imaging, DWI and DCE-MR examinations.76samples werechosen and divided into cancerous foci and noncancerous foci. Using ‘Single slice’ tomeasue ADCs, multiple ROI were selected to measure the values of Ktrans, ve, vpand kep,respectively. The values of those four parameters in different groups were compared byusing ANOVA.3. The wax blocks of18patients with pancreatic cancer were performed by Massonstaining and FAP immunohistochemical staining. The correlations among ADC, Ktrans, veand expression level of fibrosis, FAP score of pancreatic cancer were assessed by Pearsoncorrelation.Results：1. Among the three imaging methods, the consistency of two observers was morethan75%. Compared with the golden standard, the consistency of conventional combinedfunctional MR scan between observers was highest. The sensitivity, specificity, positivepredictive value, negative predictive value of the first observer were97.14%,85.17%,97.14%and85.17%. The sensitivity, specificity, positive predictive value, negativepredictive value of the second observer were94.29%,75.0%,94.29%and75.0%. Thesevalues were higher than other two methods. There were no statistical differences insensitivity, specificity, positive predictive value, negative predictive value and95%confidence interval of three methods between two observers. The differences of sensitivityand negative predictive value of each observer were statistically significant betweenconventional MR scan and conventional combined functional MR scan (P<0.05), howeverthere were no statistical differences between MDCT and conventional combinedfunctional MR scan (P>0.05). The differences of specificity of each observer werestatistically significant between MDCT and conventional combined functional MR scan(P<0.05), but no statistical differences were found between conventional MR scan andconventional combined functional MR scan (P>0.05). The difference of positive predictive value of the first observer was statistically significant between MDCT andconventional combined functional MR scan (P<0.05),no statistical difference was foundbetween conventional MR scan and conventional combined functional MR scan (P>0.05).The difference of sensitivity of the second observer was statistically significant betweenMDCT and conventional MR scan (P <0.05).2. The ADC values of cancerous foci and noncancerous foci were(1.159±0.210)×10-3mm2/s and (1.543±0.294)×10-3mm2/s, respectively, which wasstatistically significant (F=42.912, P=0.000); The Ktrans, ve, vpand kepvalues of cancerousfoci were (0.196±0.15)/min,(0.2751±0.1128),(0.0352±0.0327), and (0.937±1.17)/min,respectively. While, those of noncancerous foci were (0.987±0.63)/min,(0.1553±0.0865),(0.0854±0.0986), and (8.483±7.10)/min, respectively. The differences of Ktrans, ve,vpandkepvalues between the two groups were statistically significant (F=55.807,28.016,8.892,and41.842, respectively; P=0.000,0.000,0.004, and0.000).3. The mild negative correlation between ADC value of cancerous foci and fibrosis was notsignificant (r=-0.459, P=0.056). Significant negative correlation was found between ADCvalue of moderate and high differentiation cancerous foci and fibrosis (r=-0.564, P=0.044).Significant negative correlation was found between ADC value and FAP score (r=-0.497,P=0.036). Significant negative correlation was found between Ktransof cancerous foci andfibrosis, FAP score (r=-0.569,-0.501, respectively; P=0.014,0.034). Significant positivecorrelation was found between veof cancerous foci and fibrosis (r=0.476, P=0.046), but nosignificant correlation was found between veand FAP score (r=0.365, P=0.136).Conclusion：1. The diagnosis efficiency of conventional combined functional MR scan inpancreatic mass lesions is the highest among three methods, which provide the basis forfurther study on application of functional MR quantitative analysis in pancreatic cancer.2. The differences of ADC, Ktrans, ve, vp, kepvalues among cancerous foci andnoncancerous foci of pancreatic cancer were statistically significant, which may provide aquantitative analysis for diagnosis of pancreatic cancer.3. The significant correlations between ADC, Ktrans, veand fibrosis, FAP score of pancreatic cancer will be helpful to infer pathological characteristic. |
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