目的:胰腺癌(PC)是与癌症相关的第四大死亡,到2030年成为第二位,5年生存率为8%。考虑到与一般人群相比,其在高风险类别中的发病率增加,我们的目的是验证非对比MR协议,为了检测PC的最早阶段,这可能适合作为高危患者的筛查工具。
方法:在这项回顾性研究中,我们从放射学数据库中选择了200名患者(>40岁),2012年至2017年间进行了上腹部MRI检查。100例胰腺病变阴性,100例胰腺病变阳性(<30mm)。后一组包括:40PDAC(胰腺腺癌),42BD-IPMN(分支导管-导管内乳头状黏液性肿瘤),10PNET(胰腺神经内分泌肿瘤),4SCN(浆液性囊性肿瘤),3IPS(胰腺内脾),1MCN(黏液性囊性肿瘤)。三个读取器(R1,R2和R3)具有高,中等和低经验,分别,分析,首先,非对比MR序列(单次T2w屏气,GET1wFS,DWI和2D/3DMRCP),然后是标准的MR协议,独立,随机和匿名。读者确定或排除胰腺病变的存在,在两次阅读会议中。将这些结果与组织病理学诊断进行比较,然后分为3种不同的病变:所有病变,胰腺腺癌和实性病变。Mcnemar的测试用于比较结果。观察者之间的协议是根据两个协议中的kappa统计量确定的,然后计算了协议间协议。
结果:非对比MR方案已达到统计学参数值,范围在R3的SE(灵敏度)为83%,R1的NPV(阴性预测值)为99%。标准MR协议报告了与所提出的协议相比统计参数略有增加。然而,两种方案之间没有显著的统计学差异.拟议的非对比MR协议报告了PDAC组检测中最高的NPV(R1:99%,R2:99%,R3:98%)。在所有病变组中,对于每个读者来说,这两个协议之间的一致性非常好,范围从96%到98%。
结论:提出的非对比MR方案显示出较高的PC检测值,执行时间≤20分钟。因此,它可以作为高危患者的筛查工具。
OBJECTIVE: The pancreatic cancer (PC) is the 4th leading cancer-related death, becoming the second one by 2030, with a 5 year survival rate of 8%. Considering its increased incidence in high-risk categories compared to the general population, we aimed to validate a non-contrast MR protocol, to detect PC in its earliest phase, which could be suitable as a screening tool in high-risk patients.
METHODS: In this retrospective study, we selected 200 patients (> 40 years) from our radiological database, which performed upper abdominal MRI between 2012 and 2017. 100 were negative for pancreatic lesions and 100 positive for pancreatic lesion (< 30 mm). The latter group included: 40 PDAC (pancreatic adenocarcinoma), 42 BD-IPMN (Branch Duct- Intraductal Papillary Mucinous Neoplasm), 10 PNET(pancreatic neuroendocrine tumor), 4 SCN(serous cystic neoplasm), 3 IPS(intrapancreatic spleen), 1 MCN(mucinous cystic neoplasm). Three readers (R1, R2 and R3) with a high, medium and low experience, respectively, analysed, first, the non-contrast MR sequences (single-shot T2w breath-hold, GE T1w FS, DWI and 2D/3D MRCP), and then the standard MR protocol, independently, randomly and anonymously. Readers identified or excluded the presence of pancreatic lesion, in both reading sessions. These results were compared with the histopathological diagnosis, and then divided into 3 different classes of lesions: all lesions, pancreatic adenocarcinoma and solid lesion. Mcnemar\'s test was used to compare the results. The inter-observer agreement was determined according to the kappa statistic in both protocols, and then the inter-protocol agreement was calculated.
RESULTS: The non-contrast MR protocol has reached statistical parameters values ranging between 83% in SE (sensitivity) by R3 and 99% in NPV (negative predictive value) by R1. The standard MR protocol has reported slight increasing statistical parameters compared to those of the proposed one. However, there are not significant statistical differences between the both protocols. The proposed non-contrast MR protocol has reported the highest NPVs in the PDAC group detection (R1: 99%, R2: 99%, R3: 98%). In all groups of lesions, the agreement between the two protocols was excellent for each Reader ranging from 96 to 98%.
CONCLUSIONS: The proposed non-contrast MR protocol showed high PC detection values and a time execution ≤ 20 min. Therefore, it can be proposed as a screening tool in high-risk patients.