胰腺肿瘤64层灌注CT成像特征的初步分析

Preliminary analysis of 64 slices helical CT perfusion imaging of pancreatic tumors

目的应用64层螺旋CT灌注扫描成像技术描述正常胰腺和胰腺肿瘤的血流动力学特征，探讨灌注CT在胰腺肿瘤诊断中的应用价值。方法对36例非胰腺疾病（对照）、105例胰腺肿瘤和8例十二指肠乳头癌进行胰腺CT灌注扫描，分别测量血流量（BF）、血容量（BV）和表面通透性（PS）值。结果正常胰腺组织BF、BV和PS的平均值分别为（135．24±48．36）ml·min^-1·kg^-1、（200．55±54．96）ml／kg和（49．75±24．27）ml·min^-1·kg^-1；胰腺癌分别为（31．77±19．36）ml·min^-1·kg^-1、（66．84±39．49）ml／kg和（37．64±27．14）ml·min^-1·kg^-1；十二指肠乳头癌分别为（93．04±48．13）ml·min^-1·kg^-1（97．12±89．80）ml／kg和（41．08±18．85）ml·min^-1·kg^-1；胰腺囊肿的3项参数值接近零。胰腺癌的3项灌注参数均显著低于正常胰腺（P〈0．05）；十二指肠乳头癌的BF和BV值显著低于正常胰腺（P〈0．05），而PS值与正常胰腺无显著差异；胰腺囊肿与正常胰腺差异非常显著（P〈0．01）。结论正常胰腺CT灌注表现为组织血流量、血容量均匀，毛细血管表面通透性一致的实质性器官；胰腺癌表现为低灌注和毛细血管表面通透性降低的肿瘤；十二指肠乳头癌仅表现为低灌注，表面通透性不变；胰腺囊肿内无血流灌注。64层灌注CT有助于胰腺肿瘤的鉴别诊断。

Objective To describe the hemodynamic characteristics of normal pancreas and pancreatic tumors by 64 slices helical CT perfusion imaging, to evaluate the role of CT perfusion in the diagnosis of pancreatic tumors. Methods Perfusion CT scan was performed in 149 patients, including 36 patients with normal pancreas,105 patients with pancreatic tumors and 8 patients with duodenal papillary carcinoma. The parameters including blood flow （BF） ,blood volume （BV） and permeability surface area product （PS） were measured. Results The mean value of BF, BV and PS of normal pancreas were （ 135.24 ±48.36） ml·min^-1·kg^-1, （200.55 ± 54.96） ml/kg and （49.75 ±24.27 ） ml·min^-1·kg^-1, respectively. Pancreatic carcinoma has a lower BF,BV and PS,which were 31.77 ±19.36 ml·min^-1·kg^-1, （66.84 ± 39.49） ml/kg and （37.64 ± 27. 14 ） ml·min^-1·kg^-1 , respectively. The aforementioned parameters in pancreatic cysts were close to zero. The parameters in pancreatic carcinoma were significantly lower than those in normal pancreas（P〈0.05 ）; the BF and BV in duodenal papillary carcinoma were significantly lower than those in normal pancreas （ P 〈 0.05 ） , while the value of PS was not significantly different from that in normal pancreas ; the aforementioned parameters in pancreatic cysts were significantly different from those in normal pancreas （P 〈 0.01 ）. Conclusions In perfusion CT, normal pancreas was an organ with symmetrical BF, BV and PS. Pancreatic carcinoma was a tumor with low perfusion and decreased PS. Duodenal papillary carcinoma had decreased BF and BV with no significant change in PS. Pancreatic cyst had no blood perfusion. The 64 slice helical CT perfusion imaging was invaluable in differential diagnosis of pancreatic tumors.