MSCTA对胰腺癌胰周血管侵犯及可切除性的评估

Evaluation of MSCTA in Peripancreatic Vascular Invasion and Pre-operative Resect Ability Assessment of Pancreatic Carcinoma

目的探讨多排螺旋CT血管成像对胰腺癌周围血管侵犯及手术可切除性的判断。方法对45例胰腺癌的患者行64排螺旋CT行动态增强扫描,利用血管生长及图像融合法容积重建腹部血管,与病理结果作对比,判断胰腺癌对血管侵犯程度并行肿瘤分期和可切除判断,结果45例胰腺癌患者中,33例患者接收手术治疗,手术中发现胰腺癌的位置与CT检查结果一致,符合率为100%,其中26例术前MSCTA认为肿瘤可切除,实际成功切除21例,成功切除的阳性预测值达80.8%,其中7例MSCTA认为肿瘤不可切除,实际手术不能切除6例,不可切除性评估准确度为85.8%。结论多排螺旋CT血管成像,能反映胰腺癌的血供特征,可以直观显示肿瘤与周围结构的关系及胰周血管受侵情况,对肿瘤分期及可切除性的判断具有较高价值。

Objective To investigate the value of multi-slice CT angiography （MSCTA） in peripancreatic vascular invasion and the pre-operative resectability assessment of pancreatic carcinoma. Methods A total of 45 patients with pancreatic carcinoma were analyzed retrospectively. All the patients accepted 64 row multi-section CT plain scan and dynamic contrast enhancement scan. With volume rendering （VR） based on add vessel （AV） and image fusion technique, abdomen artery system was reconstructed. Peripancreatic vascular invasion, neoplasm staging and pre-operative assessment of pancreatic carcinoma were diagnosed , and all of these were compared with pathological study. Results 33 of these 45 patients with pancreatic carcinoma received surgical treatment. Location of pancreatic carcinoma showed by CT was the same as surgery results, with the accuracy rate was 100%. 26 cases of pancreatic carcinoma were considered resectable by MSCTA and 21 cases were successful excision in surgery, with the accuracy rate was 80.8%. 7 cases were considered nonresectable by MSCTA and 6 cases can＇ t be resectable in surgery, with the accuracy rate was 85.8%. Conclusions MSCTA could reflect the blood perfusion characterization of pancreatic carcinoma, it＇ s easy to show the relationship of the tumor and surrounding tissue, and peripancreatic vascular invasion. It＇ s higher practical value for neoplasm staging and pre-operative resectability assessment.