螺旋CT血管造影术前预测胰头癌可切除性

目的：探讨术前螺旋CT血管造影（SCTA）诊断局部进展期胰头癌侵犯胰周大血管及术前预测胰头癌普遍可切除性的价值。方法：92例疑有局部浸润的胰头癌患者术前行横断面CT及SCTA检查。比较单纯横断面CT和SCTA检查在诊断肿瘤侵犯胰周大血管以及术前预测胰头癌普遍可切除性的区别。结果：SCTA诊断胰头癌侵犯胰周大血管的敏感度、阴性预测值（98．6％、99．1％）高于单纯横断面CT（82．1％、89．6％），两者有显著差异（P〈0．01）。SCTA术前预测胰头癌普遍可切除性的敏感度、特异度、阳性预测值、阴性预测值均为100％，而横断面CT分别为100％、78．7％、81．8％、100％。两者有显著差异（P〈0．01）。结论：SCTA可精确诊断胰头癌侵犯胰周大血管情况，术前可准确预测胰头癌普遍可切除性。     

螺旋CT三期扫描对胰腺癌可切除性的分析

目的探讨螺旋CT三期扫描对胰腺癌与胰周脏器、血管侵犯及评价可切除性的价值。方法回顾分析12例胰腺癌患者术前螺旋CT多期扫描的资料,分析病灶的部位、大小及与周围脏器、胰周血管的关系等,9例与手术结果对照,3例随访证实。结果胰腺癌在胰腺实质期与胰腺组织间密度差别大,病变显示清晰;螺旋CT三期增强及图像后处理对周围脏器侵犯的准确性为75％,胰周动脉受侵评价的准确度为77．78％。结论螺旋CT三期增强及图像后处理能显示胰腺癌与周围脏器、胰周血管的情况,术前对评价胰腺癌可切除性有指导意义。     

多层螺旋CT曲面重组技术在评价胰腺癌胰周血管侵犯中的价值

目的：评价多层螺旋CT曲面重组（Curved Planar Reformations，CPR）技术在判断胰腺癌胰周血管侵犯中价值。方法：回顾27例手术证实的胰腺癌病例，所有患者均行多层螺旋CT三期增强扫描，并沿着胰周大血管进行曲面重组，根据横断面图像和横断面图像结合CPR图像分别对胰周血管是否受侵进行分析。结果：27例8段共216支血管中，术中发现72支有侵犯，144支无侵犯。其中用横断面图像术前诊断64支受侵（误诊6支），152支无侵犯（漏诊14支）；用横断面图像结合CPR图像术前诊断69支受侵（误诊3支），147支无侵犯（漏诊6支）。横断面图像和横断面图像结合CPR图像对判断胰周血管侵犯的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为80.6%，95.8%，90.6%，90.8%，90.7%；91.7%，97.9%，95.7%，95.9%，95.8%。结论：CPR图像易于显示胰周血管的全貌和与肿瘤的关系，横断面图像结合CPR图像，有助于提高判断胰腺癌胰周血管侵犯的准确性。     

多排螺旋CT血管重建技术在胰腺癌可切除型术前评估中的应用研究

目的 通过多层螺旋CT对胰腺癌患者进行三维血管重建，了解肿瘤对胰腺周围血管的侵犯情况，对肿瘤的可切除性进行前瞻性评估，评价多排螺旋CT血管重建技术在胰腺癌可切除性术评估中的价值。方法 对胰腺癌患者进行术前CT检查和三维血管重建，将图像进行容积重建（VR）、多平面重建（MPR）、最大密度投影（MIP）等处理，显示胰腺癌对周围血管的侵犯情况，通过手术结果进行分析对照。结果 接受手术治疗患者78例。术前综合评估不能切除的40例中，36例手术无法切除，准确度为90％。术前综合评估能切除的38例中，实际切除29例，准确度为76％。结论 术前用多层螺旋CT对胰腺癌患者进行三维血管重建，可提供可靠的肿瘤和周围血管侵犯情况的影像学资料，对胰腺癌术前可切除性评估有重要的临床意义。     

多层螺旋CT评价侵犯胰周血管的胰腺癌的可切除性

目的探讨多层螺旋CT（MSCT）评价侵犯胰周血管的胰腺癌的可切除性。方法收集经手术病理证实的胰腺导管细胞癌66例,根据MSCT所示的胰腺癌肿块与胰周血管之间的关系（累及血管周长、血管变形和狭窄的程度、累及血管纵轴的长度）预设五组指标判断胰周血管侵犯时胰腺癌的可切除性,计算各组指标的敏感性、特异性、准确性、假阴性、假阳性、阳性预测值及阴性预测值,并比较各组之间的差异。结果本组中行胰头十二指肠切除术（Whipple）30例;胰体尾切除17例,内引流17例,剖腹探查2例。手术探查无血管侵犯34例,血管侵犯32例。与手术病理结果对比,第一组各项指标均为优,第二组、第三组及第五组的假阴性或假阳性较高,第四组的敏感性及准确性大大低于第一组：结论综合血管受侵的周长、血管变形或狭窄程度及血管纵轴受累的长度,MSCT可用于术前评价胰腺癌的可切除性．     

螺旋CT双相扫描对胰腺癌可切除性的评价

目的前瞻性评价双相螺旋CT（HCT）术前预测胰腺癌可切除性的诊断价值。方法应朋对比剂增强HCT对57例疑似胰腺癌病例进行双相扫描,并对其中28例手术病理证实的胰腺癌病人的术前诊断和分期进行研究。结果28例胰腺癌经外科探查,17例进行根治性切除,7例进行姑息手术。可切除性的阳性预测值为70．8％。7例CT发现可切除的病例,因血管侵犯（5例）、淋巴结转移（2例）,术中未能切除。HCT作为判定胰腺癌可切除性的总的精确率为75％（21／28）。结论双相HCT扫描技术是胰腺癌术前分期和可切除性判断的一项有用方法。     

多排螺旋CT在胰腺癌诊断及术前评估中的应用

目的探讨多排螺旋CT技术在胰腺癌诊断与术前评估中的应用。方法收集经胰腺多期增强扫描并病理证实的胰腺癌38例,分析其CT征象并运用VR、MIP、MPR、CPR技术行胰腺及胰周血管三维重建,判断胰腺癌周围浸润及血管侵犯情况,评估其手术可行性。结果多期扫描中动脉期肿瘤一胰腺密度差最大,为73±18HU,肿瘤检出率达100％。38例胰腺癌中,10例显示胰周一支或多支血管受肿瘤侵犯包绕。利用VR、MIP、MPR、CPR技术对病变及其周围血管进行三维重建并结合薄层横断图像,对肿瘤手术可切除判断准确率可达82．1％。结论多排螺旋CT多期、薄层扫描,能获得高质量的CTA、MPR、CPR图像,清晰显示病灶各种征象、与胰腺及胰周解剖结构的关系;有利于病灶定位、定性及局部侵犯的评价,对肿瘤可切除判断有重要指导意义。     

多层螺旋CT对胰腺癌血管侵犯的诊断价值

目的利用多层螺旋CT对胰腺癌血管侵犯程度做出准确评价.方法对40例胰腺癌患者行多层螺旋CT双期扫描,结合利用其Inspace及MPR多方位成像技术对胰周血管侵犯的程度做出评价.结果利用多层螺旋CT技术准确的显示胰腺癌血管侵犯程度,并对肿瘤的可切除性做出判断,其结果与手术及临床相一致.结论多层螺旋CT能够准确的评价胰腺癌血管侵犯程度,对肿瘤可切除性的评估及手术方案的制定具有很高的价值.     

螺旋CT在胰腺癌诊断中的价值

目的:探讨螺旋CT在胰腺肿瘤诊断中的应用价值。方法:回顾分析经手术病理证实的43例胰腺癌的CT表现特点。结果:CT表现为胰腺内低密度肿块35例,胰腺形态和轮廓改变30例,胰胆管扩张21例,胰周血管侵犯19例,胰周淋巴转移3例,肝转移2例,腹膜种植12例。正确预测肿瘤不可切除性93.33%,正确预测可切除性为76.92%。结论:螺旋CT对胰腺癌的诊断准确率高,同时对胰腺癌是否伴有周围血管侵犯和转移的准确性也较高,亦是评价胰腺癌术前能否手术的有效方法。     

肿瘤与血管接触三级评价法在胰腺癌术前评价中的价值

目的 探讨多排螺旋CT(multidetector CT, MDCT)肿瘤与血管接触（tumor vessel contact, TVC）三级评价法在胰腺癌术前评价中的应用价值。方法 选取2017年1月至2019年3月在河南省南阳市中心医院行手术治疗的胰腺癌患者80例,术前给予MDCT检查,比较TVC三级评价法与手术探查结果的一致性。结果 80例患者,手术中共探查408支胰周血管,其中腹腔干81支,肝总动脉87支,肠系膜上动脉82支,肠系膜上静脉76支,门静脉81支;与TVC三级评价法分析一致性κ检验结果分别为0.770、0.731、0.697、0.509和0.688,P<0.05;TVC三级评价法显示侵犯的周围器官主要为十二指肠,诊断胰周血管侵犯可切除的灵敏性、特异性、阳性预测值和阴性预测值分别为100.00%、62.50%、96.07%和100.00%。肿物侵犯周围器官主要为十二指肠;CT诊断肿物可切除的灵敏性、特异性、阳性预测值和阴性预测值分别为78.00%、79.50%、80.00%和77.50%。结论 进行TVC三级评价法在可手术胰腺癌患者术前评价中有较好的应用价值,值...     

彩色多普勒血流显像在胰头和壶腹周围癌可切除性评估中的应用价值

目的　探讨彩色多普勒血流显像(CDFI)在胰头和壶腹周围癌可切除性评估中的应用价值。方法　应用CDFI检测21例胰头和壶腹周围癌患者,并与CT(增强)比较。根据肿瘤和相邻血管组织,即肠系膜上动脉(SMA)、肠系膜上静脉(SMV)和门静脉(PV)的关系,设计胰腺多普勒评分(PDS)为四个等级:1分、2分、3分和4分。结果　显示PDS评分1、2、3分者可以切除,证实符合率为95.2%,PDS评分为4分者不可切除,证实符合率为100%,总的准确率为97.8%,与CT(增强)相比,CDFI检测对胰头和壶腹周围癌可切除性评估的应用价值更高。结论　应用CDFI评估胰头和壶腹周围癌可切除性是一种有效的方法     

Preoperative evaluation of Klatskin tumor: accuracy of spiral CT in determining vascular invasion as a sign of unresectability

Background: To assess the accuracy of spiral computed tomography (CT) in predicting the resectability of Klatskin tumor as determined by vascular invasion. Methods: Twenty-one consecutive patients with Klatskin tumor who had undergone laparotomy were included in this study. The preoperative thin-section (5-mm-thick) spiral CT scans of these patients were assessed for the surgical resectability of tumor by evaluating the vascular invasion. The criterion for vascular invasion indicating unresectability was the tumoral invasion of the proper hepatic artery or main portal vein or simultaneous invasion of one side of the hepatic artery and the other side of the portal vein. Results: All nine patients with tumors thought to be unresectable on the basis of CT findings had tumors that were unresectable at surgery (positive predictive value, 100%). Of 12 patients with tumors thought to be resectable, six had resectable tumors (negative predictive value, 50%). Spiral CT failed to detect small hepatic metastasis (n= 1), lymph node metastasis (n= 1), extensive tumor (n= 2) and variation of bile duct (n= 2), which precluded surgical resection. Conclusion: Spiral CT is a reliable method for detecting vascular invasion and unresectable tumors. However, it has limitations in detecting variations of the bile duct or the intraductal extent of tumor. Received: 24 November 1999/Accepted: 26 January 2000     

Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma

PURPOSE: The aim of this prospective study was to compare sonography with helical CT in the identification and staging of ductal adenocarcinoma of the pancreas. METHODS: Sixty-four patients with histopathologically proven pancreatic ductal adenocarcinoma underwent both sonography and helical CT at our hospital between November 1, 2000, and October 31, 2001. These diagnostic imaging examinations were performed by 2 independent radiologists who were unaware of the findings of any other imaging or histopathologic examination and who assessed each case for the presence of tumor, involvement of peripancreatic vessels, the presence of metastases in the liver, and the resectability of the tumor. In the patients who underwent subsequent laparotomy, imaging-based diagnoses of overall resectability and vascular involvement were compared with surgical findings, which were considered the gold standard. Imaging-based diagnoses for the presence of hepatic metastases were compared with the findings of intraoperative sonography in patients who underwent radical resection and with the surgical findings in the patients who underwent palliative surgery; the operative findings were considered the gold standard. RESULTS: In the identification of pancreatic adenocarcinoma, sonography was more accurate (61 of 64 tumors, 95.3%) than helical CT was (57 of 64 tumors, 89.1%). In the overall prediction of resectability among the 43 patients who underwent laparotomy, sonography (81.4%) was less accurate than CT was (86.0%). In diagnosing involvement of the superior mesenteric artery, sonography (95.3%) was more accurate than CT (88.4%). The 2 methods were equally accurate in diagnosing hepatic metastases (86.0%) and involvement of the celiac trunk (100%) and the superior mesenteric vein (88.4%), but sonography was less accurate than CT for diagnosing involvement of the common hepatic artery (90.7% versus 95.3%, respectively) and portal vein (88.4% versus 93.0%, respectively). CONCLUSIONS: Sonography is more reliable than CT in identifying pancreatic adenocarcinoma, and its accuracy in staging is similar to that of CT.     

胰腺肿瘤时胰周小血管的表现和胰周血管SCTA

目的 探讨胰腺肿瘤时胰周小血管的异常改变和胰周血管SCTA临床价值,方法 20例胰腺肿瘤作了一次性屏气螺旋CT双期增强扫描,模断面观测胰周小血管的直径,并用动脉期扫描图像作SCA,进一步显示肿瘤对胰周血管和胰腺侵犯的空间解剖关系。结果 （1）分别测得胰周小血管的平均直径。（2）20例肿瘤共显示扩张小静脉13支,结论 （1）胰周小静脉的扩张可作为胰腺肿瘤早期诊断的依据之一和向胰外浸润的征象,（2）SCTA能显示肿瘤与胰周血管的关系。     

State-of-the-art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

OBJECTIVE: To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. METHODS: Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by chi2 analysis. RESULTS: Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, kappa = 0.67; superior mesenteric vein, kappa = 0.67; splenic vein, kappa = 0.85; and superior mesenteric artery, kappa = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. CONCLUSIONS: Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.     

腹部超声对胰腺肿瘤的诊断价值

目的 评价腹部超声对于临床怀疑为胰腺肿瘤病人的术前诊断价值。方法 术前，用腹部超声评价了98例临床怀疑为胰腺肿瘤的病人的声像图特征，以及它们与周围主要血管的关系(包括腹腔动脉、门静脉、肠系膜上动脉、肝动脉、脾血管及下腔静脉)，并将声像图结果与病人的临床资料、术中所见及术后病理作对照。结果 在90例接受外科手术治疗的病人中，腹部超声诊断胰腺肿瘤的敏感性为91．0％，诊断良恶性的准确率分别为94％(恶性)及54．5％(良性)。超声在发现肿瘤对周围血管的侵犯上．准确率为77．5％，在发现肿瘤的腹腔转移上，准确率87．5％。超声的准确率与CT相比，没有显著性差异。结论 对于临床怀疑为胰腺肿瘤的病人，腹部超声是一项首要的检查方法。不仅可以确立诊断，而且可以判断肿瘤是否可行切除术。     

CT泪滴状肠系膜上静脉征评价胰头癌不可切除性的意义

目的 研究CT泪滴状肠系膜上静脉（SMV）征能否可靠判断胰头癌的不可切除性,方法 回顾性分析98例经手术病理证实的胰头癌,对照分析CT表现及手术病理,评价泪滴状SMV征反映胰头癌不可切除性的敏感性,准确性和特异性。结果 在增强CT上,泪滴状SMV征结合其他CT表现可明显提高胰头癌不可切除的敏感性（从61％到89％）和准确性（从70％到91％）,但对可切除的特异性无显著影响（从100％到96％）,结论 泪滴状SMV征是胰头癌不可切除性的可靠表现,对术前手术方案的制定有指导意义。     

Involvement of superior mesenteric vessels and portal vein in pancreatic adenocarcinoma: Detection with CT during arterial portography

A prospective study was designed to determine the utility of computed tomography (CT) during arterial portography (CTAP) in the detection of superior mesenteric vessels and portal vein involvement in patients with pancreatic adenocarcinoma. Eighteen patients with adenocarcinoma of the head of the pancreas and eight patients with benign pancreatic disease were investigated with CTAP, dynamic contrast-enhanced CT, and angiography. Appropriate review was made to determine presence or absence of superior mesenteric vessels and portal vein involvement. Final diagnosis was obtained in all cases by surgical explorations. The overall accuracy rate for detecting or excluding superior mesenteric vessels and portal vein involvement was 96% (25 of 26 patients) with CTAP, 88% (23 of 26 patients) with dynamic contrast-enhanced CT, and 85% (22 of 26 patients) with angiography. No statistically significant difference in accuracy was found among the three techniques. Our results suggest that the use of CTAP is not indicated in the preoperative detection of superior mesenteric vessels and portal vein involvement in patients with pancreatic adenocarcinoma.     

多层螺旋CT胰腺双期血管成像研究

目的　探讨多层螺旋CT胰腺双期血管成像的可行性及其临床应用。方法　 46例疑胰腺癌患者行多层螺旋CT多期扫描 ,分别于动脉期和门静脉期进行血管成像。统计SSD、MIP及VR成像对正常腹腔动脉及其分支的显示率 ,统计门脉期VR成像对正常门静脉主干及其属支的显示情况。结果　VR成像对正常腹腔动脉、肠系膜上动脉、胃十二指肠动脉的显示率分别为 10 0 %、10 0 %、90 .9%。对正常门静脉主干、脾静脉、肠系膜上静脉的显示率均为 10 0 %。根据肿瘤浸润血管的情况作出可切除性判断。结论　多层螺旋CT胰腺双期血管成像是了解胰周血管情况的无创性检查方法 ,具有可行性及临床应用价值。