胰腺癌侵及血管的术前影像学判断

Role of MRA and CT in planning of surgical treatment of pancreatic carcinoma

目的 探讨联合CT与核磁共振血管成像对胰腺癌侵及血管的判断。方法 对胰腺癌术前进行增强CT扫描及核磁共振血管成像检查 ,对病灶与门静脉血管进行分级判断 ,并对照术中发现或病理结果。结果 根据增强CT扫描大体判断肿瘤与血管的邻近关系 ,其中 2例SMA、SMV三个层面未显示 ;1例SMA向右推移 ;5例PV SMV显示不良 (有的层面不显示或显示不清 ) ;2例SMA、PV SMV显示较清晰。根据核磁共振血管成像肿瘤与门静脉血管关系可分为 0级 2例 ,Ⅰ级 3例 ,Ⅱ级 3例 ,Ⅲ级 2例 ,其中行根治手术 3例 ,行根治切除并血管重建 4例 ,行内引流术 3例。结论 术前增强CT扫描可以大体判断肿瘤与血管的邻近关系 ,核磁共振血管成像可提供可靠的肿瘤与门静脉血管关系影像学资料 。

Objective To explore the role of MRA and CT in planning of surgical treatment of pancreatic carcinoma. Methods MRA and CT were preoperatively performed in 10 cases of pancreatic carcinoma and the image of MRA analyzed and classified. The relationship between tumor and PV SMV was determined and compared with pathological or operative findings. Results CT scanning could roughly assess the vascular involvement in pancreatic carcinoma. Four kinds of MRA relationship between tumor and PV SMV were divided. It was grade 0 in 2 cases, grade Ⅰ in 3, grade Ⅱ in 3 and grade Ⅲ in the left 2. Resectional surgery of regional pancreatectomy was performed in 4 cases. Conclusions The combination of CT and MRA is very useful for planning of surgical treatment of pancreatic carcinoma.