多层螺旋CT血管造影在胰腺癌周围血管侵犯术前评估中的应用价值

Vascular involvement in pancreatic carcinoma: pre-operative assessment by multislice CT angiography

目的 采用多层螺旋CT血管造影 (MSCTA)检查对胰腺癌周围血管侵犯情况以及肿瘤手术可切除性进行前瞻性评价 ,以确定其临床应用价值。方法 对 4 1例胰腺癌进行术前MSCTA检查 ,以多平面重建 (MPR)、最大密度投影 (MIP)等重建技术结合横断面图像显示胰腺癌及其胰腺周围血管 ,根据胰腺癌对周围血管的侵犯情况作出能否切除的术前评价。以手术结果作为金标准进行对照和分析 ,评价MSCTA在胰腺癌术前可切除性评估的临床应用价值。结果 33例胰腺癌患者接受了手术治疗 ,其中 11例术前MSCTA认为可切除 ,实际术中切除 9例 ,MSCTA评估可切除准确度为 82 % ;另 2 2例术前MSCTA评估为不可切除 ,实际手术无法切除 2 1,MSCTA评估不可切除准确度为 95 %。进行统计学检验分析 ,Kappa值为 0 .79,提示MSCTA术前评估结果与手术结果一致性较好。结论MSCTA术前评价胰腺癌及其周围血管侵犯程度具有相当高的正确性 ,对于胰腺癌术前可切除性评估具有重要的临床参考价值。

Objective to study the value of multislice CT angiography (MSCTA) in the pre operative assessment of vascular involvement in pancreatic carcinoma. Methods 33 cases with pathologically proven pancreatic carcinoma underwent MSCTA prior to surgical intervention. The MSCTA findings in each of the 33 patients were evaluated prospectively by four radiologists. Vascular involvement of pancreatic carcinoma was validated at the time of surgery, which was a reference standard for comparison. Correlation was made between MSCTA findings and surgical results. Results 11 out of 33 cases with pancreatic carcinoma were considered to be resectable by MSCTA with a positive predictive value of 82% in comparison with surgical findings. MSCTA also had high correlation with surgical results in assessing the non resectability of pancreatic carcinoma (positive predictive value=95%). Conclusion MSCTA could delineate the vascular involvement of pancreatic carcinoma with high accuracy and provided valuable information in the preoperative assessment of pancreatic carcinoma.