术前对比增强MRI特征评估胰腺导管腺癌病理分化及术后预后的研究

张英; 张天雨; 应晓燕; 胡亚杰; 徐杰

doi:10.13898/j.cnki.issn.2097-5252.2025.10.022

术前对比增强MRI特征评估胰腺导管腺癌病理分化及术后预后的研究

Study on the value of preoperative contrast-enhanced MRI features assessment in evaluating pathological differentiation and postoperative prognosis of pancreatic ductal adenocarcinoma

摘要

摘要:
目的： 评估术前MRI增强对比增强特征和临床特征对不同病理分化的胰腺导管腺癌（PDAC）病人的鉴别价值。
方法： 纳入符合标准的PDAC 385例，根据术后病理分为低分化组（190例）和中–高分化组（195例）。所有病人术前接受1.5T MRI检查，包括T1WI、T2WI、弥散加权成像（DWI）及多期对比增强扫描。比较2组临床–影像特征差异，多因素logistic回归筛选独立预测因子并构建联合评估模型，用Kaplan-Meier法评估2组病人的总生存期（OS）及无复发生存期（RFS）。
结果： 低分化PDAC病人CA19-9 ＞ 100 U/mL比例显著高于中–高分化组（70.53% vs 48.21%, P ＜ 0.01）。MRI分析显示，低分化PDAC更易出现动脉期低信号（93.68% vs 74.87%, P ＜ 0.01）、边缘强化（57.37% vs 38.46%, P ＜ 0.01）和MRI淋巴结肿大（39.47% vs 17.95%, P ＜ 0.01）。多因素回归结果线上CA19-9 ＞ 100 U/mL（OR = 2.316）、动脉期低信号（OR = 4.441）、边缘强化（OR = 1.728）及MRI淋巴结肿大（OR = 2.415）为低分化状态的独立预测因素。影像–临床联合评估模型效能（AUC）达0.724（95%CI: 0.676 ~ 0.768）。
结论： 动脉期低信号、边缘强化、MRI淋巴结肿大及CA19-9 ＞ 100 U/mL是术前无创评估PDAC分化程度的重要放射学和临床特征，为术前无创评估PDAC分化程度提供了重要依据。

Abstract:
Objective To evaluate the differential value of preoperative MRI contrast-enhanced features and clinical features for patients with pancreatic ductal adenocarcinoma (PDAC) of different pathological differentiations.
Methods A total of 385 PDAC cases that met the criteria were included, and divided into the poorly differentiation group (190 cases) and moderate-high differentiation group (195 cases) according to the postoperative pathology. All patients received 1.5T MRI examinations before the operation, which included T1WI, T2WI, diffusion-weighted imaging (DWI) and multi-phase contrast-enhanced scans. The differences in clinical-imaging characteristics between two groups were compared. Multivariate logistic regression was used to screen the independent predictors, and a combined evaluation model was constructed. The overall survival (OS) and recurrence-free survival (RFS) in two groups were evaluated by the Kaplan-Meier method.
Results The proportion of patients with CA19-9 ＞ 100 U/mL in poorly differentiation group was significantly higher than that in moderate-high differentiation group (70.53% vs 48.21%, P ＜ 0.01). The results of MRI analysis showed that the poorly differentiated PDAC was more prone to low signal in the arterial phase (93.68% vs 74.87%, P ＜ 0.01), marginal enhancement (57.37% vs 38.46%, P ＜ 0.01) and MRI lymph node enlargement (39.47% vs 17.95%, P ＜ 0.01). The results of multivariate regression results showed that online CA19-9 ＞ 100 U/mL (OR = 2.316), low signal in the arterial phase (OR = 4.441), marginal enhancement (OR = 1.728) and MRI lymph node enlargement (OR = 2.415) were the independent predictors of the poorly differentiated state. The efficacy (AUC) of the image-clinical combined assessment model reached 0.724 (95%CI: 0.676–0.768).
Conclusions Low signal in the arterial phase, marginal enhancement, MRI lymph node enlargement and CA19-9 ＞ 100 U/mL are the important radiological and clinical features for preoperative non-invasive assessment of the differentiation degree of PDAC, which can provide an important basis for preoperative non-invasive assessment of the differentiation degree of PDAC.

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