彩色多普勒超声对胰头癌及壶腹周围癌血管浸润的诊断观察

Usefulness of color Doppler imaging in detection of vascular invasion by carcinoma of pancreatic head and periampullary carcinoma

目的探讨彩色多普勒超声(CDI)对胰头癌及壶腹周围癌血管浸润的有效的诊断指标和临床价值。方法对34例施行 CDI、EUS、CT、MRI 和血管造影检查。结果 CDI 依据门脉壁高回声层局部消失和中断诊断门脉浸润,准确率达94%,CT、MRI、Angio 的准确性分别为79.4%、79.4%、84.3%。依赖于观察肿瘤与动脉的接触情况,以肿瘤接触肝动脉1/2周以上、以接触肠系膜上动脉作为动脉浸润的指标,准确性分别达98.4%、100%,CT、MRI、Angio 的准确性为70%～80%。结论门脉壁高回声层的变化和肿瘤对动脉包绕程度是诊断血管浸润最有用的指标,CDI 与其它影像学检查比较,是一种准确性高和实用性强的方法。

Objective To investigate the diagnostic parameters and clinical usefulness of color Doppler imaging(CDI)in detection of vascular invasion by carcinoma of the pancreatic head and peri- ampullary carcinoma.Methods Thirty-four cases were subjected to CDI,EUS,CT,MRI and angio- graphic examinations.Result We diagnosed portal vein invasion by loss or disconnection of the hypere- chogenic wall of the portal vein with an accuracy rate of 94%.The accuracy rates of CT,MRI,angiog- raphy were 79.4%,79.4%,84.3%,respectively.With respect to arterial invasion,use of'vascular contact with tumor'over half circumference for diagnosis of hepatic arterial invasion resulted in its accu- racy of 98.4%,and for diagnosis of superior mesenteric arterial invasion,'vascular contact with tumor'had an accuracy rate of 100%.The accuracy rates of CT,MRI,angiography were 70-80%. Conclusion Loss or disconnection of the hyperechogenic wall of the portal vein and the degree of arteri- al contacting with tumor are most useful parameters in diagnosis of vascular invasion by tumor.Com- pared with other imaging modalities,CDI is a more useful method in detection of vascular invasion by cancer.