多层螺旋CT与MR评估胰腺肿瘤血管不可切除性的比较

Comparison of Multi-slice Spiral CT and Magnetic Resonance Imaging in Evaluation of the Unresectability of Blood Vessels in Pancreatic Tumor

目的比较多层螺旋CT(MSCT)与MR评估胰腺肿瘤血管不可切除性的应用价值。方法回顾性分析14例胰腺癌患者的MSCT及MR胰腺增强扫描图像,对胰周主要血管的受累情况进行评价和比较。对经手术治疗者以手术结果为金标准,比较二者对血管不可切除性的评估有无显著差异,并计算二者的准确性。结果MSCT及MR检查对血管受累分级及血管不可切除性评估均有显著性差异(P<0.05)。MSCT评估血管不可切除性的敏感度、特异度、准确度、阳性预测值及阴性预测值分别为77.8%、95.0%、91.8%、77.8%和95.0%,MR则分别为66.7%、90.0%、85.7%、60.0%和92.3%。结论在胰腺肿瘤的血管不可切除性判定方面,增强MSCT在一定程度上优于增强MR。

Objective To compare the values of multi-slice spiral CT （MSCT） and magnetic resonance imaging （MRI） in evaluating the unresectability of blood vessels in pancreatic tumor. Methods Images obtained from MSCT and MRI of pancreas in 14 patients with pancreatic cancer were retrospectively reviewed. MSCT scanning included arterial phase, pancreatic-portal phase, and delay-phase. MRI scanning included fat-suppressed T2WI, dual-echo T1WI, and fat-suppressed T1WI before and after injection of contrast （ arterial phase, pancreatic-portal phase, delay-phase, and late delay phase ）. Seven patients received operations within two weeks after the examinations. The staging of peripancreatic blood vessels in MSCT and MRI images was evaluated and compared. The veracity of MSCT and MRI in assessing the unresectability of peripancreatic blood vessels was calculated and compared according to the findings in operation. Results All the tumors were observed in MSCT and MRI images. Statistical difference existed in staging of peripancreatic blood vessels and in evaluating their unresectability between MSCT and MR （ P 〈 0.05 ）. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the unresectability assessed by MSCT were 77.8%, 95%, 91.8%, 77.8%, and 95%, respectively, and those assessed by MR were 66.7%, 90%, 85.7%, 60%, and 92.3%, respectively. Conclusion Dynamic MSCT is better than dynamic MR to some extent in evaluating the unresectability of peripancreatic blood vessels in pancreatic tumor.