胰头腺癌动静脉双期CT扫描与相关病理对照研究

Adenocarcinoma of the Head of the Pancreas:Arterial and Venous Phase CT Assessment with Pathologic Correlation

目的 :探讨胰头腺癌CT表现的病理基础 ,提高胰头癌早期诊断的准确性。材料和方法 :将71例胰头癌的电子束CT资料与病理资料进行对照研究。采用Imatron公司C -150型电子束CT扫描设备对胰腺进行动静脉双期扫描 ,根据胰头肿块与胰腺实质强化的程度不同将胰头癌分为等密度和低密度肿瘤 ,分别观察等密度肿块和低密度肿块的组织学表现。结果 :30例手术切除的肿瘤中16例呈等密度 ,其余为低密度。41例不能切除的病例中仅4例为等密度 ,37例为低密度。等密度肿瘤组织学表现为肿瘤内血管成分多 ,间质纤维增生少 ,肿瘤细胞丰富 ;而低密度肿瘤则表现为血管成分少 ,间质增生纤维明显 ,肿瘤细胞少并伴有肿瘤组织坏死。等密度肿块的病理类型与低密度肿块无明显不同(p>0.05)。等密度肿块切除率明显高于低密度肿块(p<0.01) ,其平均径线小于低密度肿块(p<0.01) ,且对血管的侵袭性较小。结论 :肿瘤强化程度的不同显示了肿瘤组织成分的不同 ,早期胰头癌增强后常表现为小的等密度肿块 。

Purpose:To explore the pathologic essence of electronic beam computed tomography(EBCT) findings of adenocarcinoma of the head of pancreas and to improve the accuracy of EBCT in assessing the small carcinoma of pancreatic head.Materials and Method:EBCT dual-phase arterial and venous phase scans obtained in 71 patients with adenocarcinoma of pancreatic head were evaluated.According to the enhancement of the lesions comparing with the pancretic parenchyma,the tumors were divided into isoattenuating tumors and hypoattenuating tumors.EBCT findings were closely correlated with histopathlogic findings.Results:Of 30 resectable tumors,16 were isoattenuating and others were hypoattenuaing compared with the remaining pancreatic parenchyma.Of 41 unresectable tumors,only 4 were isoattenuating and 37 were hypoattenuating.The isoattenuating tumors show more local fibrotic tissue response,rich cells and vessels of tumor than hypoattenuating tumors.There is no distinct different in pathologic type between isoattenuating mass and hypoattenuating mass(p>0.05).The average diameter and the surrounding vessles aggression of isoattenuating tumors were less than one of hypoattenuating tumors.The resectablity of isoattenuating tumors was higher.Conclusion:The enhanced degree of mass depends on different component of tissue in tumor.The early adenocarcinoma of pancreatic head generally reveals a small isoattenuating mass.The arterial phase EBCT may be improve the detectability of adenocarcinoma of pancreatic head.