胰腺内分泌肿瘤术前影像学定位诊断方法的选择

The choice of preoperative localization procedures of pancreatic endocrine tumors

目的:评估经腹部超声(TAUS)、内镜超声(EUS)、CT、MR、选择性血管造影(SAG)及动脉钙刺激静脉采血测定胰岛素(ASVS)在胰腺内分泌肿瘤(PET)术前定位中的价值。方法:对65例经手术及病理证实的PET的术前影像学检查资料进行回顾性分析,比较不同检查方法对PET的定位结果,并探讨PET的影像学表现和特点。结果:各种检查方法术前定位的敏感性和准确性分别为:TAUS为47.4%和41.5%,EUS为90.0%和75.0%,CT为86.9%和82.8%,MR为85.7%和77.4%,SAG为16.7%和16.7%及ASVS为83.3%和83.3%。结论:PET的术前影像学检查方法的选择应从易到难,先行非侵入性的TAUS、MSCT或MR检查;如仍为阴性,则考虑EUS或ASVS;最后为手术探查及术中超声检查。

Objective To study the relative value of transabdominal ultrasound（TAUS）, endoscopic ultrasound（EUS）,CT, MR, selective angiography（SAG）, and intraarterial calcium stimnlation（ASVS） for preoperative localization of pancreatic endocrine tumors （PET）. Methods Data of preoperative imaging techniques applied in 65 patients with surgically and pathologically confirmed PETs were retrospectively analyzed. Results The sensitivity and accuracy for preoperative application of each kind of the procedures were 47.4% and 41.5% in TAUS; 90.0% and 75.0% in EUS; 86.9% and 82.8% in CT; 85.7% and 77.4% in MR; 16.7% and 16.7% in SAG and 83.3% and 83.3% in ASVS respectively. Conclusions Each examination has its advantage and disadvantage. Easier non-invasive techniques, such as TAUS, CT or MR should be considered first; if they turn out to be negative, EUS or ASVS could be considered. Surgical exploration and/or intraoperative US remain the final resorts.