【作者】 王平；

【导师】 郭顺林；

【作者基本信息】 兰州大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的：探讨磁共振DWI及表观弥散系数(ADC)在诊断急性胆源性胰腺炎的应用价值。方法：选取自2010年3月一2010年10月本院13例临床诊断为急性胆源性胰腺炎患者、17例结石性梗阻性黄疸患者。病例组男14例,女16例,平均49.5±15.7岁。15例健康志愿者为同一时间内在我院进行健康检查者,男8例,女7例,平均43.3±16.9岁,均排除消化胆道系统疾病和其他影响胰腺功能疾病。所有受试者磁共振检查均使用GE Signa Horizon CV/i1.5T超导MR扫描仪,常规胰腺轴位T1WI、轴位T2WI、冠状位T2WI及MRCP扫描后行DWI检查,DWI检查以体部线圈为射频发射线圈及接收线圈,采用单次激发SE—EPI序列,TR=6000ms, TE随b值变化而变化(71.4-81.4 ms),层厚5mm,间隔1mm,FOV36-45mm,矩阵=128×128,NEX=I,取扩散敏感系数b(值)=300、500、700s/mm2,各扫描一次,扫描时间均为24s。所有DWI图像用GE工作站Functool 2分析软件对扫描数据进行自动图像分析处理。对影像质量作出评价,对质量合格的图像测量胰腺的ADC值。分别取胰腺头、体、尾部3个面积大小约为64mm2的感兴趣区(regions of interest,ROI),得到3个表观扩散系数(apparentdiffusion coefficient,ADC)值,取其平均值。统计分析各组内不同b值及b值相同的各组间ADC值差异。收集病例组患者的丙氨酸氨基转换酶(ALT)、天冬氨酸转氨酶(AST)、直接胆红素(DBIL)总胆红素(TBIL)血淀粉酶(AMY)及C反应蛋白(CRP)检查结果,并与胰腺ADC值进行相关性分析。对2例急性胆源性胰腺炎患者治疗后应用磁共振DWI检查随访。结果：急性胆源性胰腺炎患者胰腺肿大,ADC值低于对照组ADC值(P<0.05)；在b值为500、700s/mmm2时,梗阻性黄疸组患者ADC值低于对照组高于急性胰腺炎组患者(P<0.05)。病例组ADC值与实验室检查结果之间,除急性胰腺炎组自变量C反应蛋白(CRP)P值小于0.05以外,其余都大于0.05,均无统计学意义。两例急性胰腺炎经过治疗后,胰腺DWI图像信号有所降低,ADC值较前略有增高。结论：应用DWI检查可以辅助临床早期诊断急性胆源性胰腺炎,推荐胰腺DWI检查b值使用500 s/mm2。DWI成像结合常规MR检查可以评价临床治疗效果。更多还原

【Abstract】 Objective:To evaluate the efficacy of diffusion weighted imaging and apparent diffusion coefficient (ADC) in diagnosing acute biliary pancreatitis.Methods:MRI was performed with routine sequences and diffusion weighted imaging on 12 patients with acute biliary pancreatitis,17 patients with obstructive jaundice and 15 normal subject.We measured the pancreas’ADC values of the acceptable images after assessed the quality of the images in the regions of interest. The linear regression were used to determine the relationship between ADC values and laboratory examination data.Results:There were statistically significant differences between patients with acute biliary pancreatitis and normal subject, and the ADC values of patients with acute biliary pancreatitis was decreased. The ADC values of patients with obstructive jaundice lower than normal subject, and higher than patients with acute biliary pancreatitis when b value were 500 and 700 s/mm2.Using linear regression analysised the relationship of the two groups between the results of laboratory examination data and ADC values. P value less than 0.05 between C-reactive protein in acute biliary pancreatitis and the ADC values, the rest were larger than 0.05, which had not statistically significant.Two cases of acute biliary pancreatitis treated two weeks were followed up with DWI, and the pancreatic signal decreased.Conclusion:DWI is a powerful tool for evaluating acute biliary pancreatitis and has a potential to determine at its early stage of progression.MRI routine sequences combined with DWI can evaluate the clinical efficacy.更多还原