胰腺癌的CT诊断

CT Diagnosis of Carcinoma of Pancreas

总结手术、病理证实的20例胰腺癌和4例法特壶腹癌的 CT 表现。本组 CT 总的确诊率为95%。胰癌主要 CT 征象是腺体局部增大及轮廊改变、密度降低、双管征、胰周粘连淋巴结增大脂肪层受侵犯。壶腹癌主要特征是显著的胆道扩张,仅1例有胰头部癌浸润。CT 漏诊胰癌1例主要原因是对胰头部增大未予重视。另外,本文总结 CT 初诊未排除胰癌和胰囊腺瘤的8例进行了鉴别诊断讨论。其中慢性胰炎1例虽出现胰头增大但未有胰管扩张。胰区其它恶性肿物2例,CT 所见同胰癌,但有年青、发展快特点。总胆管结石病例均见总胆管远段腔内低度阻塞物。至于胰区囊状病变,1例有典型外伤史,表现支持外伤性胰囊肿,另1例有包虫囊肿合并感染的特征。此外,本总结还讨论了提高早期胰癌诊断率的影象学方法。

A summary of CT signs of 20 cases of carcinoma of pancreas and 4 cases of cancer of Vater amp- ulla,all proved surgically and patho- logically,was presented,The overall CT diagnostic accuracy in this series was 95%.The main features of carci- noma of pancreas were:regional enla- rgemement and change of contour of the gland,decrease in CT attenuation value,dilatation of both CBD and pancreatic dubcts,and involvement of peripancreatic space with lymphaden- opathy and obliteration of fat planes.Significant dilatation of CBD was noted in the cases of cancer of Vater ampulla with only a case sho- wing infiltration of the head of pan- creas.Besides,a discussion on diffe- rential diagnosis was made on the 8 cases initially taken by CT as could not rule out cancer or cystic tumor of pancreas.Among them:a case of chronic pancreatitis showed enlarge- meat of pancreatic head but with no ductal dilatation;2 cases of other malignancies of pancreas had the same features as carcinoma of pancreas but were younger in age and showed fast developing of the tumors;cases of calculus of the distal segment of CBD all showed obstructing substance of low CT attenuation value inside the lumen;and of 2 cystic lesions,1 had history of abdominal trauma with the lesion consistent with pancreatic pseudocyst,and the other was chara- cteristic of an infected hydatid cyst. Early detection of the disease with multiple imaging modalities was also discussed.