胰腺癌侵犯胰周动静脉CT诊断标准的临床价值

Evaluation of CT diagnostic criteria for peri-pancrcatic artery and vein invasion in pancreatic carcinoma

目的评价CT诊断胰腺癌侵犯胰周动脉或静脉标准的临床应用价值。方法多层螺旋CT（MDCT）检查诊断为胰腺癌的72例患者中，43例行手术治疗，术后病理均证实为胰腺导管细胞癌。其中，行胰十二指肠切除术15例，手术探查认为肿瘤不可切除者28例。术中仔细探查胰周肠系膜上动脉、腹腔干、肝动脉、肠系膜上静脉及门静脉主干。共发现受侵胰周动脉16支，未受侵胰周动脉61支；受侵胰周静脉42支，未受侵胰周静脉38支。结果胰周动脉受侵的CT诊断标准为动脉被肿瘤包埋、或肿瘤包绕动脉大于管周1／2且管壁浸润或管腔狭窄，其敏感性（75．0％，12／16）较传统胰周血管受侵的CT诊断标准（87．5％，14／16）低，但特异性（95．1％，58／61）较后者（90．2％，55／61）高。胰周静脉受侵的CT诊断标准：静脉管腔闭塞、肿瘤包绕静脉大于管周1／2、管壁浸润、管腔狭窄、肠系膜上静脉呈泪滴征，具备上述表现之一即判为静脉受侵。其敏感性（92．9％，39／42）较传统标准（69．0％，29／42）高，特异性两者相似（均为97．4％，37／38）。结论胰周动静脉的不同CT诊断标准，较传统胰周血管受侵CT诊断标准的判断准确性高，是一种值得推荐的CT诊断标准。

Objective To evaluate the clinical value of different CT diagnostic criteria for peripancreatic artery and vein invasion in pancreatic carcinoma through comparison with the findings on surgical exploration. Methods Of 72 patients of having suspected pancreatic carcinoma were examined by multiplane spiral CT. Among 43 confirmed by surgical pathology; 15 underwent pancreaticeduodenectumy; 28 were found to have unresectable tumors. The peri-pancreatic major vessels including the superior mesenteric artery, celiac artery, hepatic artery, superior mesenteric vein and portal vein were explored carefully during surgical exploration. Results The criteria for peri-pancreatic artery invasion was the presence of one of the following signs： artery embeded in tumor, or more than half of the artery circumference involved by tumor with wall irregularity or stenosis. The sensitivity of the above described criteria was 75.0% （12/16）. If the criteria of tumor involvement exceeding half of the vessel circumference were adhered to, the sensitivity was 87.5% （14/16）, which was high than the former, but the specificity was lower than that of the former one （90.2% versus 95.1% ）. The criteria for peri-pancreatic vein invasion was presence of any of the following signs： vein obliteration, more than half of the vein circumference involved by tumor, vein wall irregularity, vein stenosis, tear-drop sign of superior mesenteric artery. The sensitivity of the above described criteria was 92.9% （39/42）, higher than that of the criteria that more than half of the vessel circumference was involved by the tumor （ 69. 0%, 29/42 ）, but the specificity of both criteria was the same （ 97.4%, 37/38 ）. Conclusion For assessing peri-panereatie artery and vein invasion, using the combination of different CT diagnostic criteria has higher accuracy than when using only criteria of more than half of vessel circumference involved by tumor.