摘要：同步正子掃描/磁振造影整合儀可在磁振造影的高磁場環境中正常運作正子訊號偵測 元件。正子掃瞄為一種功能性影像，對於病灶的偵測和範圍都極為敏感及精確。磁振 造影對於軟組織有極佳解析度，也有功能性影像：動態顯影磁振造影影像可得知腫瘤 的血流和滲透性參數；分子擴散影像可用來區分正常和腫瘤組織;磁振造影頻譜分析術 可分析腫瘤組織内的化學物的含量。本研究將應用正子掃描/磁振造影影像評估胰臟疾 病，包括於術前偵測胰臟癌及轉移病灶，區分良性和惡性病灶，並針對胰臟癌高危險 群無症狀個案做篩檢，以期發現早期癌症。本計晝為三年前瞻性的研究，第一年預計納入60位胰臟癌病患和30位高危險群受試 者；第二年預計納入30位胰臟癌病患，30位有腫瘤樣之慢性胰臟炎病患和30位高危險 群受試者；第三年預計納入60位高風險表現之胰臟囊狀腫瘤病患和30位高危險群受試 者，希望利用正子掃描/磁振造影影像，提供腫瘤種類、大小和位置的資訊，配合多種 功能性影像參數，偵測胰臟癌微小轉移病灶和惡性度，區分良性和惡性病灶於慢性胰 臟炎病患和具有高風險表現之胰臟囊狀腫瘤病患。同時希望利用各種功能性影像參數 篩檢出高危險群無症狀個案之早期腫瘤，並預測胰臟癌復發率和病患存活預後。
Abstract: Integrated PET/MR imaging has several potential advantages over or PET/CT in their stand-alone configurations. The excellent soft-tissue contrast of MR images and the advanced functional MR imaging options available complement the molecular information PET provides. Thus, it would be a quite useful tool for preoperative staging in patients with pancreatic cancer. Patients with chronic pancreatitis carry higher risk to develop pancreatic cancer. However, there is no good biomarker to differentiate chronic inflammation from cancer. Furthermore, patients with pancreatic cancer were usually under staged in traditional imaging which might direct different decision of treatment options. Combining high sensitivity of dedicated MRI with molecular imaging of PET in PET/MRI as a single examination will be potential beneficial in evaluation of pancreatic diseases, including detecting small lesions and metastatic foci in pancreatic cancer, differentiating malignancy from benign lesions in chronic pancreatitis, and detecting early cancer in asymptomatic individuals who has high risk of pancreatic malignancy.One of the most striking benefits of PET/MR in pancreatic lesion is its ability to provide multi-parametric functional imaging, including dynamic contrast-enhanced (DCE) MRI, diffusion weighted imaging (DWI), MR spectroscopy and metabolic information by PET. While traditional morphologic imaging was difficult to distinguish from benign lesions and pancreatic cancer, functional imaging could add significant information and possible be able to identify true malignancy in these cases. In asymptomatic patients with high risk for pancreatic cancer, both morphologic and functional imaging provided by PET/MR could possibly identify early pancreatic cancer and enable early surgical resection in these patients.PET can provides improved molecular detection and characterization of lymph nodes as benign or malignant for node staging. DCE-MRI is a non-invasive quantitative technique that can characterize tumor angiogenesis and detect microvascular perfusion. DWI enables qualitative and quantitative assessment of tissue diffusivity. MR spectroscopy facilitates the study of cellular metabolism and in vivo detection of abnormalities.This study is a 3-year prospective clinical study. The purpose of this study is to explore the performance of integrated PET/MR in the evaluation of pancreatic disease, using PET radiotracers (18F-FDG) and functional MRI (DCE-MRI, DWI, MR spectroscopy), in patients with pancreatic cancers, mass-forming chronic pancreatitis, cystic pancreatic tumors with “high risk stigmata and worrisome features，，，and in high-risk asymptomatic individuals.In the first year, we will enroll 60 patients with pancreatic cancer (30 patients with resectable pancreatic cancer and 30 patients with unresectable pancreatic cancer, including locally advanced and metastatic disease) and 30 high-risk asymptomatic individuals. In the second year, we will enroll 30 patients with pancreatic cancer, 30 patients with mass-forming chronic pancreatitis, and 30 high-risk asymptomatic individuals. In the third year, we will enroll 60 patients with cystic pancreatic tumors with “high risk stigmata and worrisome features” and 30 high-risk asymptomatic individuals. The diagnostic performance of PET/MR will be evaluated and multiple functional parameters will be correlated with tumor characteristics and patients’ survival. The imaging biomarkers determined by PET/MR will greatly transform clinical treatment towards personalized medicine, and further improve the survival outcome in these patients.