螺旋CT多期扫描技术诊断胰腺癌的价值及临床意义

Multi-phase Spiral CT:Value for Diagnosis of Pancreatic Carcinoma and its Clinical Application

目的：研究螺旋CT多期扫描技术在胰腺癌中的诊断价值及其临床意义。方法：68例胰腺癌患者行螺旋CT多期扫描，扫描时间为注射造影荆后18～25S、40～45S和60S左右，比较正常胰腺组织和肿瘤在平扫和三期的增强变化。依照CT征象诊断胰腺癌并行术前评估，并与手术结果比较。结果：正常胰腺组织在胰腺期的增强值明显高于其它两期（F=12．32，P（0．01）；胰腺-病灶增强值胰腺期高于其它两期（F一15．1l，P〈0．01），肿块在胰腺期能够清晰显示。胰周血管在胰腺期显示满意，诸动脉在动脉期、胰腺期与门静脉期相比，有显著性差异（P〈0．01）；诸静脉在胰腺期、门静脉期与动脉期相比有显著性差异（P〈0．01）。42例不可切除的肿瘤中，血管受侵者24例（57％），其中胰周小静脉扩张者19例（45％）。33例术前认为可切除的肿瘤，术中仍有7例不可切除。结论：螺旋CT三期扫描诊断胰腺癌，胰腺期和门静脉期应作为首选方案，它具有非常重要的临床意义。

Objective：To evaluate multi-phase spiral CT in the diagnosis of pancreatic carcinoma and its clinical application. Methods： Sixty-eight cases with pancreatic carcinoma underwent triple-phase spiral CT, scan time was 18～25s,40～45s and 60s after the contrast injection. Images obtained during each phase were interpreted by three radiologists who evaluated the presence of normal pancreas, tumor and vascular invasion, assessed the tumor according to CT findings, and then correlated it with surgical results. Results： Density difference of normal pancreas was the greatest on images obtained in the pancreatic phase （F= 12.32,P〈0.01）,mean tumor-gland attenuation difference was the greatest on those obtained in the pancreatic phase （F= 15. 11, P〈0. 01）. Tumor and peripancreatic vasculature were clearly visualized in the pancreatic phase. For vessels detection,sensitivity of arteries obtained in the pancreatic and arterial phase was superior to that of those obtained in portal phase （P〈0.01） ;sensitivity of veins obtained in pancreatic and portal phase was better than that of those obtained in arterial phase （P〈0.01）. Of the 42 unresectable cases, vascular invasion was detected in 24 cases （57 %） and small vein dilatation was detected in 19 cases （45 %）. 33 cases were thought of as resectable before operation, but 7 cases were not resectable during operation. Conclusion： In multi-phase spiral CT diagnosis of pancreatic carcinoma, pancreatic and hepatic phases should be the first choice,which is of great clinical significance.