基于CT灌注成像技术在模型中定量分析胰腺癌肿瘤分期中的意义和作用

目的探讨CT灌注扫描灌注参数在定量分析胰腺癌肿瘤分期中的意义和作用。方法选取2014年5月至2017年1月经本院病理证实的胰腺癌患者,在术前一周内均进行上腹部CT灌注检查。根据CT表现依据第七版美国癌症联合会胰腺癌分期标准对胰腺癌进行TNM分期,对比分析CT灌注参数在胰腺癌分期中的意义。结果 CT灌注扫描对胰腺癌T1、T2、T3和T4准确率分别为100%,81.4%,74.2%和77.3%。CT灌注扫描对胰腺癌N0和N1准确率分别为83.9%和62.2%。CT灌注参数中,BV在各组间差异有统计学意义,BF在I期与IV期中差异有统计学意义(P<0.05)。结论胰腺CT灌注扫描检查在胰腺癌术前分期中具有较高的准确率,能够准确的判断胰腺癌的恶性程度,在临床工作中具有重要的意义和作用。

CT灌注成像在胰腺癌患者分期诊断中的价值研究

目的 探讨CT灌注成像在胰腺癌患者分期诊断中的价值.方法 以在我院治疗的48例肝癌患者作为本次研究对象,另外选取48例健康人作为对照组,对两组患者分别行CT灌注成像,比较两组患者相关参数.结果 CT灌注完成后,观察组的PS、PS/BF值均显著高于对照组,BF、BV则显著低于对照组,差异显著（P〈0.05）.结论 CT灌注成像在胰腺癌患者分期诊断中的应用价值显著,BF、PS、BV及PS/BF等可作为胰腺癌CT灌注的重要指标.

CA19-9、CA242、CEA水平与胰腺癌肿瘤分期的相关性和诊断价值分析

目的分析血清CA19-9、CA242、CEA表达水平与胰腺癌患者的肿瘤分期的相关性和诊断价值。方法选取本院2017年1月~2018年6月收治的胰腺癌患者30例建立观察组,在同期选取28例胰腺良性病变患者建立对照组。分析其中血清CA19-9、CA242、CEA水平表达与胰腺癌临床分期的关系、分析诊断与鉴别诊断的价值等。结果观察组血清CA19-9、CA242、CEA表达水平对比对照组均明显更高;且在术后观察组的血清CA19-9、CA242、CEA水平对比术前均有明显的下降;TS3+TS4以及Ⅲ期+Ⅳ期患者的血清CA19-9、CA242、CEA表达水平对比TS1+TS2与Ⅰ期+Ⅱ期患者显著更高(P<0.05)。结论胰腺癌患者CA19-9、CA242、CEA表达水平对胰腺癌患者的术前诊断以及临床分期的判断方面均存在一定的参考价值。

MSCT及MRI在诊断及术前评估胰腺癌患者的价值

目的:探讨多层螺旋CT(MSCT)及磁共振成像(MRI)在诊断及术前评估胰腺癌患者的价值。方法:选择2019年6月至2022年6月期间我院收治的560例胰腺占位病变患者,所有患者接受MSCR、MRI检查。以手术或病理检查为金标准,不同影像学手段诊断胰腺癌的价值、对血管浸润及淋巴结转移的诊断分析、胰腺癌的手术可切除性、术前胰腺癌分期。结果:共560例胰腺占位病变患者,经病理诊断为胰腺癌有404例,胰腺非恶性病变有156例。MSCR诊断胰腺癌的敏感度、特异度、符合率分别为86.63%、72.44%、82.68%;MRI诊断胰腺癌的0敏感度、特异度、符合率分别为84.16%、72.44%、80.89%。两种方式诊断胰腺癌的价值比较无明显差异(P>0.05)。血管浸润:病理诊断确定有、无分别为408例、152例,MRI诊断有、无分别为343例、217例;MSCT诊断有、无分别为369例、191例。淋巴结转移:病理诊断有、无分别为202例、358例,MRI诊断有、无分别为270例、290例,MSCT诊断有、无分别为281例、279例。560例患者中有125例接受了手术。MSCT术前对胰腺癌T分期的诊断与术后病理分期的符合率为64.80%,MRI术前T分期的诊断与术后病理分期的符合率为73.60%。MRI与MSCT诊断对胰腺癌术前T分期的比较无统计学差异(P>0.05)。经MSCT评估为可行手术的有116例,经MRI评估为可行手术的有118例,两种方式评估胰腺癌的可切除性比较无统计学差异(P>0.05)。结论:MSCT、MRI均能准确地评价胰腺占位病变的血管浸润与淋巴结转移情况,诊断效能相当,且术前分期与术后病理分期的一致性良好,对于术前指导是否性手术切除的价值良好。

Treatment of Unresectable Carcinoma of Pancreas with ^(125)I Implantation and ^(125)I Plus Gemcitabine

Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC.

Pancreatic cancer–Staging laparoscopy

Objective: Accurate staging of patients with pancreatic cancer is crucial to clarify whether meaningful resection is indeed possible. Staging laparoscopy has been suggested as a tool for staging which may spare up to two-fifth of these patients from undergoing nontherapeutic laparotomy. A controversy exists, however, as to whether the procedure should be used routinely or selectively in these patients with no evidence of metastasis on noninvasive staging. This review aims to evaluate the available literature critically, identify its limitations and address the existing controversies. Methods: The current available English literature was reviewed on this topic. Results: A direct and conclusive comparison of the controversial literature is difficult because of inconsistent use of high-quality CT scans, different study designs and dissimilarity of judgment for non-resectability among patients staged by laparoscopy. However, recent studies reveal that not more than 14% of the patients benefit from diagnostic laparoscopy when a dual-contrast thin cut and 3-D digital reformatting CT scan has been performed previously. Conclusion: We conclude that routine use of diagnostic laparoscopy does not appear warranted in all patients with pancreatic cancer, especially for patients with early-staged pancreatic cancer or non-pancreatic periampullary cancers, because diagnostic laparoscopy is costly and ultrasonography is largely operator-dependent. Rather, selective use is appropriate, especially in patients with a large primary tumor, a tumor in the body or tail of the pancreas, equivocal findings of metastasis on CT, the presence of ascites, severe weight loss, hypoalbuminemia, and a markedly elevated CA 19–9.

Pancreatic cancer–Neoadjuvant therapy

In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. Surgical therapy currently offers the only potential monomodal cure for pancreatic adenocarcinoma. However only 10%–20% of patients present with tumors that are amenable to resection, and even after resection of localized cancers, long term survival is rare. The addition of chemoradiation therapy significantly increases median survival. To achieve long-term success in treating this disease it is therefore increasingly important to identify effective neoadjuvant/adjuvant multimodality therapies. Preoperative chemoradiation for potentially resectable pancreatic cancer has the following advantages: (1) neoadjuvant treatment would eliminate the delay of adjuvant treatment due to postoperative complications; (2) neoadjuvant treatment could avoid unnecessary surgery for patients with metastatic disease evident on restaging after neoadjuvant therapy; (3) downstaging after neoadjuvant therapy may increase the likelihood for negative surgical margins; and (4) neoadjuvant treatment could prevent peritoneal tumor cell implantation and dissemination caused during surgery. This review systematically summarizes the current status, controversies, and prospects of neoadjuvant treatment of pancreatic cancer.

Pancreatic cancer–Endosonography

EUS is the most sensitive imaging procedure for the detection of small solid pancreatic masses and is accurate in determining vascular invasion of the portal venous system. Even compared to the new CT-techniques EUS provides excellent results in preoperative staging of solid pancreatic tumors. Compared to helical CT-techniques EUS is less accurate in detecting tumor involvement of superior mesenteric artery. EUS staging and EUS-guided FNA can be performed in a single-step procedure, to establish the diagnosis of cancer. There is no known negative impact of tumor cell seeding due to EUS-FNA. Without FNA EUS and additional methods are not able to reliably distinguish between inflammatory and malignant masses.

Preliminary experience of helical tomotherapy for locally advanced pancreatic cancer

Radiotherapy for locally advanced pancreatic cancer is technically difficult and frequently associated with high-grade digestive toxicity.Helical tomotherapy(HT)is a new irradiation modality that combines megavoltage computed tomography imaging for patient positioning with intensity-modulated fan-beam radiotherapy.Its recent availability opens new fields of exploration for pancreatic radiotherapy as a result of its ability to tailor very well-defined dose distributions around the target volumes.Here,we report the use of HT in two patients with locally advanced pancreatic cancer. Doses to the bowel,kidneys and liver were reduced significantly,which allowed for excellent treatment tolerance without any high-grade adverse effects in either patient.

Pancreatic cancer–Diagnostics: PET

Important challenges for imaging of pancreatic cancer are the late presentation of the disease and the fact that therapeutic management is of limited success. Surgery continues to be the only treatment that offers potential cure. Therefore, defining whether the patient has an operable tumor remains the ultimate aim of imaging in pancreatic cancer. PET and PET/ CT with fluorodeoxyglucose (FDG) are of value in differential diagnosis between pancreatitis and carcinoma and for the detection of remote metastases, but relatively inefficient in the detection of nodal disease. The detection of recurrent disease is of little clinical consequence. FDG-PET may be considered as a prognostic marker for patient survival or therapy response, but evidence for these applications is lacking. Future applications will broaden the spectrum of tracers applied using molecules for the assessment of proliferation and detection of receptors.

Analysis of Clinical Syndromes in 47 Patients with Pancreatic Cancer at Late Stage

Objective:To analyze the law governing the distribution of traditional Chinese medicine(TCM) syndromes of pancreatic cancer.Methods:The authors used retrospective study to statistically analyze TCM syndromes of patients,separated complex syndromes and calculated the frequency of appearance of single syndromes.Results:The patients mainly suffered from 4 syndromes:blood stasis syndrome,qi stagnation syndrome,qi(yang) deficiency syndrome,and phlegm dampness syndrome.The distribution of syndromes is rarely related to sex,age and morbid site of patients.Conclusion:Owing to complicated distribution of its syndromes,pancreatic cancer should be diagnosed and treated according to its characteristics of deficiency in origin and excess in superficiality.