Diagnostic Performance of Contrast-Enhanced MRI With Secretin-Stimulated MRCP for Non-Calcific Chronic Pancreatitis: A Comparison With Histopathology
Diagnostic Performance of Contrast-Enhanced MRI With Secretin-Stimulated MRCP for Non-Calcific Chronic Pancreatitis: A Comparison With Histopathology
复制标题
DOI：
10.1038/ajg.2015.297
复制
发表时间：
2015-11-01
影响因子：
9.8
通讯作者：
Freeman, Martin L.
中科院分区：
文献类型：
--
作者：
Trikudanathan, Guru;Walker, Sidney P.;Freeman, Martin L.
结论：诊断慢性腹痛患者的非钙化性慢性胰腺炎（NCCP）具有挑战性和争议性。对比增强磁共振成像（MRI）与分泌素刺激MRCP（sMRCP）提供了一种安全和非侵入性的方式来诊断轻度CP，但其结果与组织病理学无关。我们的目的是评估一系列MRI/sMRCP结果与接受全胰腺切除术联合胰岛自体移植（TPIAT）的NCCP患者队列中手术组织病理学的相关性。方法：2008年至2013年期间接受TPIAT治疗NCCP的成人患者从我们机构的手术数据库中确定，如果他们在手术前一年内进行了MRI/sMRCP，则将其纳入。在TPIAT时通过头部、体部和尾部的楔形活检从切除的胰腺中获得组织学，并由对成像特征不知情的胃肠道病理学家进行分级。纤维化评分（FS）≥ 2分视为异常，FS ≥ 6分为重度纤维化。在考虑年龄、性别、吸烟、饮酒和体重指数（BMI）后，对预测纤维化的MRI特征进行多变量回归分析。结果：共纳入NCCP和MRI/sMRCP患者57例，其中女性49例，男性8例。ROC曲线分析显示，两个或两个以上的MRI/sMRCP特征提供了区分异常（FS >= 2）与正常胰腺组织的敏感性（65%）、特异性（89%）和准确性（68%）的最佳平衡。两个或两个以上的特征提供了预测严重纤维化（FS >= 6）的最佳截止值（敏感性88%，特异性78%）。肝纤维化程度与病变特征数呈显著正相关（r = 0.6，P < 0.0001）。考虑到年龄，吸烟和BMI后的线性回归显示，主胰管不规则，T1加权信号强度比胰腺和椎旁肌，胰泌素注射后的十二指肠充盈是显着的独立预测纤维化。结论：MRI/sMRCP结果和组织病理学NCCP之间存在很强的相关性。
OBJECTIVES: Diagnosis of non-calcific chronic pancreatitis (NCCP) in patients presenting with chronic abdominal pain is challenging and controversial. Contrast-enhanced magnetic resonance imaging (MRI) with secretin-stimulated MRCP (sMRCP) offers a safe and noninvasive modality to diagnose mild CP, but its findings have not been correlated with histopathology. We aimed to assess the correlation of a spectrum of MRI/sMRCP findings with surgical histopathology in a cohort of NCCP patients undergoing total pancreatectomy with islet autotransplantation (TPIAT).METHODS: Adult patients undergoing TPIAT for NCCP between 2008 and 2013 were identified from our institution's surgery database and were included if they had MRI/sMRCP within a year before surgery. Histology was obtained from resected pancreas at the time of TPIAT by wedge biopsy of head, body, and tail, and was graded by a gastrointestinal pathologist who was blinded to the imaging features. A fibrosis score (FS) of 2 or more was considered as abnormal, with FS >= 6 as severe fibrosis. A multivariate regression analysis was performed for MRI features predicting fibrosis, after taking age, sex, smoking, alcohol, and body mass index (BMI) into consideration. A quantitative receiver operating characteristic (ROC) curve analysis was performed and Spearman rank correlation coefficient (r) was calculated.RESULTS: Fifty-seven patients (females=49, males=8) with NCCP and MRI/sMRCP were identified. ROC curve analysis showed that two or more MRI/sMRCP features provided the best balance of sensitivity (65%), specificity (89%), and accuracy (68%) to differentiate abnormal (FS >= 2) from normal pancreatic tissue. Two or more features provided the best cutoff (sensitivity 88%, specificity 78%) for predicting severe fibrosis (FS >= 6). There was a significant correlation between the number of features and severity of fibrosis (r = 0.6, P < 0.0001). A linear regression after taking age, smoking, and BMI into consideration showed that main pancreatic duct irregularity, T1-weighted signal intensity ratio between pancreas and paraspinal muscle, and duodenal filling after secretin injection to be significant independent predictors of fibrosis.CONCLUSIONS: A strong correlation exists between MRI/sMRCP findings and histopathology of NCCP.