不同影像学方法在胰腺癌诊断中的价值与比较

Different Imaging Techniques in the Diagnosis of Pancreatic Carcinoma

目的分析胰腺癌患者影像学检查的意义及过去14年胰腺癌患者影像学检查的发展趋势,以提高对胰腺癌影像学检查的认识。方法回顾性分析北京协和医院1995年10月至2009年10月414例胰腺癌患者的各种影像学检查资料。结果 (1)内镜下逆行胰胆管造影(encoscopic retrograde cholangio-pancreatography,ERCP)和超声内镜(en-doscopic ultrasonography,EUS)是诊断胰腺癌最敏感的影像学手段;(2)1995至2003年与2004至2009年比较,以B超为首诊检查的患者人数显著下降(90.3%vs.74.5%,P=0.000),而以CT做为首诊检查的患者人数在增加(9.0%vs.24.6%,P=0.000);(3)ERCP对胆管及胰管病变检出率与磁共振胆胰管成像(magnetic resonance cholangio-pancre-atography,MRCP)符合率分别为86.7%和75.0%,MRCP与B超、CT、EUS比较是检测胰胆管病变最敏感的检测手段(P<0.05);(4)CT血管重建对脾动静脉、门静脉和肠系膜血管浸润的检出率达80%、80%和60%。结论了解各种影像学手段对胰腺癌诊断的特点,对胰腺癌临床早期诊断及治疗具有指导意义。

Objective To analyze the role of different imaging techniques in the diagnosis of pancreatic carcinoma and learn the changing in the past fourteen years, in order to improve the knowledge of pancreatic carcinoma. Methods The clinical data and imaging results of 414 patients with pancreatic carcinoma who received imaging examinations in our hospital from August 1995 to August 2009 were retrospectively ana- lyzed. Results The most sensitive imaging techniques were encoscopie retrograde cholangio-panereatogra- phy （ERCP） and endoscopic uhrasonography （EUS）. Comparison of the periods between 1995-2003 and 2004-2009 showed that rate of using ultrasound as the initial choice has decreased significantly from 90.3% to 74.5% , while the rate of computed tomography was increasing （9.0% vs. 24.6% ） （both P =0. 000）. The coincidence rate between magnetic resonance cholangio-pancreatography （MRCP） and ERCP in the diagnosis of pancreatic duct and bile duct was 86.7% and 75.0%, respectively; furthermore, compared with ultrasound, CT, and EUS, MRCP was the most sensitive technique in detecting lesions in these locations. Angio-CT showed a performance of 80% in the detection of vascular invasion in splenic vessels and in portal vein, and 60% in the superior mesenteric vessels. Conclusion Different imaging techniques have varied performances in the diagnosis of pancreatic carcinoma and should be applied reasonably.