胰腺癌:多排螺旋CT三期增强及曲面重建的评价

Pancreatic adenocarcinoma:role of triphasic enhancement and curved planar reformations using multi-detector spiral CT in tumor detection and vascular invasion assessment

目的探讨多排螺旋CT三期扫描及曲面重建对胰腺癌显示与胰周血管侵犯评价的价值。方法对54例临床怀疑胰腺癌患者采用多排螺旋CT行薄层三期动态增强扫描,其中经手术或临床随访证实23例胰腺癌入选本研究,并采用胰腺期图像沿胰胆管以及胰周主要血管行曲面重建,分析肿瘤在三期图像上显示以及胰周血管受累情况。结果肿瘤于胰腺期图像上与胰腺实质密度差异最大,肿瘤-胰腺CT值差于动脉期、胰腺期及门脉期,分别为28.02±11.13,35.67±11.60和24.52±13.13,胰腺期高于动脉期和门脉期(p<0.01),而动脉期与门脉期差别无统计学意义(p>0.05)。曲面重建能直接显示肿瘤与周围解剖结构的关系以及血管受侵的情况。结合横断位图像,曲面重建共检出64条血管受侵,对6例手术患者血管无受累作出正确评价。结论多排螺旋CT动态增强胰腺期有利于肿瘤显示和胰周血管侵犯的评价。曲面重建可以直观显示肿瘤与周围结构的关系及血管受侵情况,并且能加强与临床医生间的信息传递。

Objective To investigate the value of triphasic enhancement and curved planar reformations using multi-detector spiral CT in tumor detection and vascular invasion assessment of pancreatic adenocarcinoma. Methods Fifty-four patients with suspected pancreatic adenocarcinoma underwent contrast enhanced triphasic multi-detector spiral CT. Twenty-three patients with surgical or clinical following confirmed pancreatic adenocarcinoma were enrolled in this study. Curved planar reformations (CPR)were generated along cholangiopancreatic duct and peripancreatic major vessels at pancreatic phase images. The visualization of tumor and vascular invasion at triphasic images was analyzed. Results Maximal density difference between pancreatic parenchyma and tumor was observed at the pancreatic parenchyma phase. The CT value difference of tumor-to-pancreatic parenchyma was 28.02±11.13, 35.67±11.60 and 24.52±13.13 at the artery phase (AP), the pancreatic parenchyma phase (PPP) and the portal vein phase (PVP) respectively. The CT value difference of tumor-to-pancreatic parenchyma at PPP was higher than that at the AP and the PVP (p < 0.01), while the difference between the AP and the PVP was not statistical significant (p > 0.05). CPR could depict anatomic relationship of tumor with surround structures and visualize the vascular invasion directly. Sixty-four involved vessels were documented. Combining with transverse images, CPR made correctly evaluation of vascular invasion in six patients who underwent operation. Conclusion The PPP of dynamic enhanced multi-detector spiral CT was helpful in tumor detection and vascular invasion of pancreatic adenocarcinoma. CPR could demonstrate anatomic relationship of tumor with surround structures and the vascular invasion directly, and enhance communication with the referring physician.