多排螺旋CT三期增强扫描术前评价胰腺癌可切除性的手术对照研究

Preoperative 3-phase contrast-enhanced multidetector-row computed tomography image in evaluating resectibility of pancreatic carcinoma:a comparison with postoperative pathological results

目的探讨多排螺旋CT(MDCT)三期增强扫描术前观察胰周主要血管侵犯并评价肿瘤可切除性的价值。方法回顾分析25例MDCT三期增强的图像资料,分析三期增强扫描胰腺癌与正常胰腺的密度差及胰周主要动静脉是否受侵等,并与手术结果进行对照。结果 25例胰腺癌病例中,胰头部17例,体部6例,胰尾部2例。肿瘤直径≤2cm的小胰腺癌2例,>2cm的胰腺癌23例。25例胰腺癌均行手术治疗,其中12例行胰十二指肠切除术,13例行姑息性手术或剖腹探查,4例(9支)误判不可切除,3例(8支)误判可切除。MDCT动脉期利于观察动脉血管的受累情况及进行CT血管造影(CTA)成像,可以较好地评估肿瘤对胰周动脉的侵犯情况;在胰腺期,胰腺肿块与正常胰腺存在最大密度差,此期最易发现胰腺肿块;在肝脏期,肝脏实质与转移瘤密度差最大,易于病灶的显示与定性诊断。结论 MDCT增强扫描对胰腺癌的诊断及评估胰周主要动静脉受侵情况有重要价值,结合各项其他标准,有利于术前评估肿瘤的可切除性。

Objective To evaluate the role of 3-phase contrast-enhanced multidetector-row computed tomography （MDCT） in observing blood vessel invasion around the pancreas before operation and its value in assessing the resectibility of pancreatic carcinoma. Methods The 3-phase contrast-enhanced MDCT scanning images of 25 patients with pancreatic carcinoma were retrospectively analyzed. The intensity difference in 3-phase contrast-enhanced MDCT scanning images between pancreatic carcinoma and normal pancreas and the involvement of major blood vessel were analyzed; the results were compared with those of operative finding. Results Seventeen patients had pancreatic carcinomas at the head of pancreas, six at the body of pancreas, and two at the tail of pancreas. The diameters of pancreatic carcinomas were ≤2 cm in two patients, and the others with diameter 〉2 cm. All the 25 patients were surgically treated, 12 receiving pancreaticoduodenectomy and 13 receiving palliative surgery. Four （9 blood vessels）patients were misdiagnosed as unresectable and 3 （8 blood vessels）as resectable. The arterial phase of MDCT was helpful for observation of the blood vessel involvement and for performing computed tomographic arteriography （CTA）, which can better assess the tumor invasion of arteries around the pancreas. The largest intensity difference between normal pancreas and pancreatic carcinomas was found during the pancreatic phase, making it easier to discover pancreatic carcinoma. The largest intensity difference between liver and metastatic tumor was found in the liver phase, making it easier for qualitative diagnosis. Conclusion Three phase contrast-enhanced scanning with MDCT has great value for diagnosis of pancreatic carcinoma and for assessment of major blood vessel involvement. MDCT, together with other criteria, can help to assess the resectibility of tumor before operation.