Is Gadolinium Necessary for MRI Follow-Up Evaluation of Cystic Lesions in the Pancreas? Preliminary Results
Is Gadolinium Necessary for MRI Follow-Up Evaluation of Cystic Lesions in the Pancreas? Preliminary Results
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DOI：
10.2214/ajr.08.1068
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发表时间：
2009-01-01
影响因子：
5
通讯作者：
Babb, James
中科院分区：
文献类型：
--
作者：
Macari, Michael;Lee, Terrence;Babb, James
客观的。我们研究的目的是确定在胰腺囊性病变的随访评估中是否需要钆。材料和方法。确定了 56 名在初始 MRI 中检测到胰腺囊性病变并接受后续 MRI 治疗的患者。平均囊肿大小为 1.9 厘米，平均随访时间为 9.1 个月。 MRI 包括造影剂施用前的多采集 T1 和 T2 加权序列以及施用钆前后的 3D 脂肪抑制 T1 加权图像。两名放射科医生仅使用第二次检查中未增强的 T1 和 T2 加权序列独立审查了整个初始检查和后续 MRI。每位放射科医生提出以下三个建议之一：1、6-12 个月内无需随访或随访影像学检查； 2、囊肿抽吸；或3、囊肿切除术。四个星期后，使用第二次检查的对比增强图像重新评估影像学研究。提出了使用相同结果的第二项建议。同一患者的观察者间和观察者内差异以 kappa 系数和决策一致的次数百分比进行总结。计算了不使用和使用钆时管理决策发生变化的次数百分比的 95% CI。结果。两位不同读者之间的解释一致性（当使用相同的 MRI 解释技术进行后续监测时）为 87.5%，评估观察者间变异的 kappa 系数为 0.075，表明两位读者之间仅有轻微的一致性。然而，单个读者在有或没有对比度增强图像信息的情况下提供的治疗建议仅在 4.5% 的情况下不一致。在不使用钆和使用钆的情况下，95.5%（107/112；kappa = 0.67）的建议是一致的，表明基本一致。对钆影响观察员建议改变的五个案例进行了回顾性共识审查。钆增强序列上没有任何东西会专门改变管理决策的变化，这五个病例中管理决策的变化很可能只是与病变分类的预期变化有关，而不是与钆的使用有关。结论。钆的使用对胰腺囊性病变的后续 MR 评估影响极小。
OBJECTIVE. The purpose of our study was to determine whether gadolinium is necessary in the follow-up evaluation of pancreatic cystic lesions.MATERIALS AND METHODS. Fifty-six patients with pancreatic cystic lesions detected on initial MRI and who underwent follow-up MRI were identified. Mean cyst size was 1.9 cm, and mean follow-up was 9.1 months. MRI included multiacquisition T1- and T2-weighted sequences before contrast administration and 3D fat-suppressed T1-weighted images before and after gadolinium administration. Two radiologists independently reviewed the entire initial examination and follow-up MRI using only unenhanced T1- and T2-weighted sequences from the second examination. Each radiologist made one of three recommendations: 1, no follow-up necessary or follow-up imaging in 6-12 months; 2, cyst aspiration; or 3, cyst resection. Four weeks later, imaging studies were reevaluated with the contrast-enhanced images from the second examination. A second recommendation using the same outcomes was made. Interobserver and intraobserver variations for the same patient were summarized in terms of kappa coefficients and the percentage of times the decisions were concordant. A 95% CI for the percentage of times management decisions would change without and with gadolinium was calculated.RESULTS. Concordance between the two different readers for the interpretations (when using the same MRI interpretation technique for follow-up surveillance) was 87.5% with a kappa coefficient to assess interobserver variation of 0.075, suggesting only slight agreement between the two readers. However, treatment recommendations provided by a single reader with and without information from the contrast-enhanced images were discordant only 4.5% of the time. Recommendations were concordant without and with gadolinium 95.5% (107/112; kappa = 0.67) of the time, suggesting substantial agreement. A retrospective consensus review of the five cases in which gadolinium effected a change in the observer's recommendation was performed. There was nothing on the gadolinium-enhanced sequences that would specifically alter a change in a management decision, and it is likely that the changes in management decisions in these five cases were simply related to expected variations in categorizing lesions rather than to the use of gadolinium.CONCLUSION. The use of gadolinium has minimal impact in the follow-up MR assessment of pancreatic cystic lesions.