多层螺旋CT在原发性腹膜后肿瘤术前评估中的应用

The Value of Multislice Spiral CT in the Preoperative Evaluation of Primary Retroperitoneal Tumor

目的探讨多层螺旋CT(MSCT)在原发性腹膜后肿瘤术前评估中的意义。方法 26例经手术证实的原发性腹膜后肿瘤患者术前均行MSCT,并使用多平面重组(MPR)、容积再现(VR)、最大密度投影(MIP)等重建技术成像,对照分析影像结果与术中及病理结果。结果 MSCT通过多种后处理技术可清楚显示肿瘤与周围脏器和血管的解剖关系,CT所见26例中9例呈浸润性生长,包膜不完整;5例肾脏受压变形、移位;3例累及胰腺;3例侵犯十二指肠肠壁;2例累及输尿管;6邻近大血管受侵犯。26例均行手术切除,肿瘤均为单发,直径4cm-18cm。术中所见26例中,7例包膜不完整,9例侵犯邻近器官或组织,5例邻近血管受侵。与手术结果相比,术前MSCT对原发腹膜后肿瘤包膜评价的灵敏度和特异度分别为85%和84%;对肿瘤邻近器官侵犯评价的灵敏度和特异度分别为75%和69%;对邻近血管受侵评价的灵敏度和特异度分别为83%和90%。26例病理结果良性肿瘤及肿瘤样病变15例,恶性肿瘤11例,MSCT对肿瘤良恶性鉴别的准确率为74%。结论术中所见的肿瘤与周围脏器、血管的解剖关系与CT表现基本相符;病理所见与CT表现对应良好,MSCT有利于腹膜后肿瘤的术前可切除性评估及术中导向。

Otbjeetive To explore the value of preoperative evaluation of multislice spiral CT （MSCT） in primary retroperitoneal tumor. Methods 26 cases of primary retroperitoneal tumor confirmed by surgery underwent preoperative MSCT and reconstruction techniques such as multiplanar reformat（MPR）,Volume rendering（VR）, Maximum intensity projection（MIP） etc were used. Imaging results were compared with the intraoperative and pathological results, Results Anatomic relationship of the tumor with adjacent organs and blood vessels could be clearly showed by a variety of MSCT post-processing techniques. Among all of 26 cases, invasive growth with incomplete capsules were seen in 9 cases, kidney compressed deformation and displacement of the kidney were seen in 5 cases; pancreas involved in 3 cases, duodenum intestinal wall involved in 3 cases, ureteral involved in 2 cases and large blood vessels involved in 6 cases. 26 patients were performed surgical resection. All of the tumor are single with the diameters were 4 cm-18 cm. During the operation, incomplete capsules were seen in 7 cases, adjacent organs or tissues involved in 9 cases, adjacent blood vessels involved in 5 cases. Compared with surgical results, sensitivity and speciality rate of preoperative MSCT evaluation for tumor＇ s capsules, involvement of adjacent organ, involvement of adjacent blood vessels were 85% and 84%, 75% and 69%, and 83% and 90%, respectively. There were 15 cases of benign tumors and 11 cases of tumor-like lesions. The benign and mahgnant differentiation accuracy of MSCT was 74%. Conclusion Intraoperative results of anatomic relationship between tumor and adjacent organs, blood vessels were consistent with MSCT. It is helpful for preoperative evaluation and intraoperative guidance for retroperitoneal tumors with MSCT.