多层螺旋CT血管成像评价胰腺癌侵犯胰周血管

目的 观察多层螺旋CT血管成像(MSCTA)评价胰腺癌胰周血管受侵的价值.方法 对49例胰腺癌患者行螺旋CT增强扫描,结合多平面重建、最大密度投影、最小密度投影、曲面重建、三维容积再现等后处理技术对胰周主要血管进行成像.结果 49例患者中胰头、胰颈部癌33例,钩突癌8例,胰体癌5例,胰尾癌2例,全胰腺癌1例.胰周主要血管受侵包括腹腔干3 例,肝总动脉7例,肠系膜上动脉6例,脾动脉8例,门静脉16例,肠系膜上静脉24例, 脾静脉11例, 下腔静脉2例.MSCTA判断血管受侵准确率为87.75%,敏感度为88.57%,特异度为85.71%,阳性预测值为93.94%,阴性预测值为75.00%.结论 MSCTA能直观准确地显示胰腺癌对胰周血管的侵犯,术前MSCT多期增强扫描判断胰腺癌的胰周血管是否受侵对手术具有指导意义.

MSCT evaluation of peripancreatic vascular invasion in pancreatic carcinoma

Objective To observe the value of mutislice spiral computed tomography angiography (MSCTA) in evaluation of peripancreatic vessel invasion in pancreatic carcinoma. Methods Forty-nine patients with pancreatic cancer confirmed by surgery and pathology underwent MSCT enhancement scanning. The row data obtained in every phase were transferred to ADW 4.2 postprocessing work-station. CTA were produced with multi-planar reconstruction (MPR), maximum intensity projection (MIP), minimum intensity projection (MinIP), and curve planar reformation (CPR) and volume rendering (VR) to assess the peripancreatic vessels, including celiac axis (CA), common hepatic artery (CHA), superior mesentericartery (SMA), splenic artery (SA), portal veins (PV), superior mesenteric vein (SMV), splenic vein (SV) and inferior vena cava (IVC). CT findings were compared with surgical and histopathologic results. Results In all 49 patients, lesions located at the head and cervical of pancreases in 33 patients, at uncinate in 8, 5 at the bodies and 2 at the tails, and 1 at whole part of pancreas. The main peripancreatic vessel invasion including CA (n=3), CHA (n=7), SMA (n=6), SA (n=8), PV (n=16), SMV (n=24), SV (n=11) and IVC (n=2). For prediction of vessel encroachment, MSCTA had an accuracy of 87.75%, sensitivity of 88.57%, sensitivity of 85.71%, positive predictive value of 93.94% and negative predictive of 75.00%. Conclusion MSCTA is a direct-viewing and accurate method in assessment of major peripancreatic vessel invasion of pancreatic carcinoma. The prospective prediction of peripancreatic vessel invasion with MSCTA is helpful to surgery.