多层螺旋CT对胰腺癌的术前分期及可切除性评价

仅有约20％的胰腺癌患者在就诊时尚有手术切除的机会。多层螺旋CT对于胰腺癌术前不可切除的阳性预测值较高，而可以切除的阴性预测值相对较低，主要是因为未发现小的肝脏或腹膜转移以及未发现主要血管受侵。注射对比剂后增强扫描的胰腺期及肝脏期对于术前分期及可切除性评价至关重要。     

多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值

目的分析多层螺旋CT三期增强扫描在胰腺癌术前评估中的价值。方法将临床因怀疑胰腺癌而申请MDCT检查的病例行三期增强扫描,扫描时相及延迟时间分别为：动脉期20s、胰腺实质期45s、门脉期70s,并进行图像后处理;图像分析内容包括肿瘤位置、有无周围器官及主要血管的侵犯、有无器官转移、腹膜或腹腔转移等,最后评估肿瘤是否可以手术切除,并与手术结果对照。结果多层螺旋CT三期增强扫描对于胰腺癌术前可切除性评价的阳性预测值、阴性预测值、敏感性、特异性及准确性分别为100％、87．5％、97．1％、100％及97．6％。结论胰腺实质期与门脉期应作为胰腺癌术前MDCT增强的最基本扫描时相,如果需要进一步观察胰周动脉走行及肿瘤的供血情况,可以加做动脉期扫描;以原始横断位图像为基础,结合MPR、MIP、VR、CPR等重建技术,MDCT对于胰腺癌的术前可切除性评价多能做出正确诊断。     

螺旋CT动态增强扫描及血管成像在胰腺癌术前评估中的价值

目的 探讨螺旋CT动态增强扫描及血管成像在胰腺癌术前评估中的价值.方法 45例胰腺癌患者接受螺旋CT动态增强扫描及血管成像检查,根据检查结果进行肿瘤分期和可切除性判断,并将其与术中探查结果进行对比.结果 45例患者中,27例患者接受手术治疗,其中22例术前CT评估为可切除,实际成功切除17例,阳性预测值为77%;5例术前CT评估为不可切除,手术探查均不能切除.肿瘤部位、肝脏转移和淋巴结转移方面,术前CTA评估与术中探查结果一致.结论 螺旋CT动态增强扫描及血管成像可直观显示肿瘤与周围组织结构的关系及血管受侵情况,在胰腺癌术前肿瘤分期和可切除性评估方面具有较高价值.     

胰腺癌手术可切除性的术前CT及MRI评估

摘 要：［目的］ 评价CT和MRI术前判断胰腺癌手术可切除性的应用价值。［方法］ 回顾性分析经病理证实的40例胰腺癌的CT和MRI征象,包括肿瘤大小、边界、血管侵犯、淋巴结转移及远处转移,并与手术及病理对照。［结果］ 术前影像学显示肿瘤大小平均4.5cm,边界清晰18例,血管受累不可切除26例,淋巴结转移21例,肝脏转移8例,腹膜及远处转移6例。术前影像学对于血管可切除性、淋巴结转移诊断的灵敏度、特异性、准确率分别为76.9%、40.7%、52.5%和70.0%、65.0%、67.5%。手术可切除组和不可切除组肿瘤大小（P=0.546）和肿瘤边界（P=0.053）没有统计学差异。［结论］ CT和MRI是评估胰腺癌可切除性的有效方法。     

胰腺癌辅助化疗的预后与复发因素分析

目的 探讨影响胰腺癌辅助化疗者预后及复发的因素,以期早期发现复发来提高远期生存。方法 回顾性分析2008年1月至2015年9月77例胰腺癌切除术后行辅助化疗患者的资料,分析影响胰腺癌辅助化疗的预后及复发的因素。结果 单因素分析显示分化程度、切缘情况、肿瘤最大径、脉管内癌栓、血管侵犯、淋巴结转移、术前癌胚抗原（CEA）水平、中性粒细胞与淋巴细胞比值（NLR）及是否完成辅助化疗与预后有关（P＜0.05）;多因素分析显示淋巴结转移、低分化、R1切除及未完成辅助化疗是胰腺癌预后差的独立危险因素。肿瘤最大径、T分期、血管侵犯及术前CEA水平与胰腺癌复发有关,Logistic回归分析显示血管侵犯及术前CEA水平升高是胰腺癌复发的独立危险因素,且复发者复发后生存时间更短。结论 对于胰腺癌辅助化疗患者,淋巴结转移、低分化、R1切除及未完成辅助化疗是影响预后的危险因素。血管侵犯及术前CEA水平升高者更易复发,且复发后生存时间更短,对这些易早期复发患者术前应重视评估病情及慎重考虑是否需要术前治疗。     

肝脏颗粒细胞瘤的诊疗(附1例报告)

目的:报告并总结1例肝脏颗粒细胞瘤的初步诊治经验。方法:对近期本院收治的1例肝脏颗粒细胞瘤的临床资料进行回顾性总结。结果:患者术前、术中临床均诊断为原发性肝癌,影像学检查及手术探查均未发现卵巢及附件病变,术后病理确诊为肝脏颗粒细胞瘤。结论:肝脏颗粒细胞瘤是罕见的肝脏肿瘤类型,术前诊断困难,确诊有赖于病理。以手术切除肿瘤加局部及全身化疗的综合治疗为宜。     

局限期胰腺癌放化疗的临床试验研究进展

根据术前肿瘤与相邻血管的关系胰腺癌分为可手术切除、临界可切除和不可手术切除病变。就诊时大部分患者已为局部晚期或出现远处转移,只有20%患者有手术机会,放化疗对于胰腺癌至关重要。本文回顾近年来的相关文献,着重介绍局限期胰腺癌新辅助放化疗、立体定向放疗及放化疗联合免疫治疗的临床试验研究进展。     

胰腺癌放疗研究进展

近年来的研究表明,对于可手术切除胰腺癌患者,不论手术切缘状况、原发肿瘤大小、有无淋巴结转移、肿瘤分化程度等,均能从术后辅助放化疗中获益;术前新辅助放化疗的多项Ⅱ期临床研究均提示治疗耐受性良好.对于局部晚期不能手术切除胰腺癌患者的治疗目前尚无金标准,但以吉西他滨为基础的化疗或以吉西他滨为基础的放化疗与最佳支持对症治疗相比延长了总生存率.     

增强CT、选择性血管造影对胰腺癌手术不可切除性的评估

背景与目的：胰腺癌手术不能切除的主要原因是胰周大血管受侵,本文旨在探讨增强CT、选择性血管造影（selective angiography,SAG)评估胰腺癌手术不可切除性的可靠性。方法：回顾性分析我院自1996年8月7日－2000年8月12日期间收治的经手术探查证实为胰腺导管腺癌患者67例,其中胰头癌63例,胰体尾癌4例;术前行增强CT、SAG者分别为31、54例。根据具体的判定指标,由手术医师对患者术前CT或SAG片中胰周大血管的受侵程度进行评估（放射医师的报告作为参考）,评估结果与术中血管的实际受侵情况比较,评估上述方法的可靠性。结果：31例行增强CT检查者中,CT提示不可切除者13例,手术证实不可切除者12例,预告值为91％。54例行SAG者中,造影提示不可切除者28例,手术证实不可切除者23例,预告值为82％。增强CT和SAG对于评估胰腺癌不可切除的敏感性、特异性、阳性预告值分别为60％、91％、92％和77％、79％、82％。增强CT和SAG联合评估胰腺癌不可切除的敏感性、特异性、阳性预测值分别为91％、100％、100％。结论：增强CT、SAG作为非手术技术手段是术前评估胰腺癌不可切除性的可靠方法,两种方法联合使用可提高预测的敏感性、特异性和阳性预告值。     

CT在胰腺癌术前诊断中的意义

目的探讨CT在胰腺癌的术前诊断中的临床应用价值.方法回顾性分析23例胰腺癌的CT表现和可切除性评估与手术结果对照.结果胰腺癌术前CT表现正确评估8例患者可根治切除,并经手术证实;其余15例手术未能根治切除的病例,CT做出正确评估10例.结论胰腺癌术前CT诊断对评估手术切除有较高的临床应用价值.     

^(68)Ga-FAPI-04 PET/CT在胰腺癌与胰腺炎鉴别诊断中的价值北大核心

目的:探讨^(68)Ga-FAPI-04 PET/CT在胰腺癌与胰腺炎鉴别诊断中的应用价值。方法:回顾性分析西南医科大学附属医院核医学科2020年09月至2021年03月61例^(68)Ga-FAPI-04 PET/CT胰腺摄取阳性患者的影像学资料,并根据术后病理、病史、血淀粉酶、血清肿瘤标志物、彩超及MRI检查、随访结果等将病例分为胰腺癌组(16例),急性胰腺炎组(12例),慢性胰腺炎组(11例)及非特异性摄取组(22例),并对这四组病例进行分析。结果:四组间SUV_(max)值比较,差异有统计学意义(P<0.05);Post hoc分别比较,急性胰腺炎组与胰腺癌组的SUV_(max)值均显著大于慢性胰腺炎组及非特异性摄取组;慢性胰腺炎组SUV_(max)值大于非特异性摄取组,差异有统计学意义(P<0.05);当尤登指数为0.773时,SUV_(max)分界值为6.45,此时^(68)Ga-FAPI-04 PET/CT对应的灵敏度为90.9%,特异度为86.4%,准确性为87.9%,阳性预测值76.9%,阴性预测值95.0%;急性胰腺炎组与胰腺癌组的SUV_(max)值差异没有统计学意义,但通过摄取示踪剂的形态及同机CT表现可进行鉴别;胰腺癌肿块大小与SUV_(max)值呈正相关关系。结论:^(68)Ga-FAPI-04作为一种新的示踪剂,通过PET/CT显像在胰腺疾病的诊断上有很大的潜力,在鉴别胰腺病灶良恶性方面有重要价值。     

Évaluation de la résécabilité des tumeurs pancréatiques par le scanner conventionnel. Corrélation radiochirurgicale

Pancreatic carcinoma is one of the most serious tumors. One hundred seventy-five patients with pancreatic tumors underwent an abdominal CT scan for the conventional balance of resectability. The results of this examination were compared with the surgical results. Statistical analysis showed 95% sensitivity, 28.8% specificity, and 93% accuracy in determining the resectability of the lesion. The positive predictive value came to 35.08%, while the negative predictive value was 93.8%.     

Inadequacy of computed tomography in assessing patients with esophageal carcinoma after induction chemoradiotherapy

BACKGROUND: Induction chemoradiotherapy followed by surgery may improve survival of patients with esophageal carcinoma. Computed tomography (CT) has been used to evaluate the tumor response after completing induction chemoradiotherapy. The authors examined the ability of CT to evaluate the pathologic tumor response to induction therapy and to stage the tumor correctly. METHODS: Preinduction and postinduction chemoradiotherapy CT scans were reviewed retrospectively for 50 patients enrolled in a protocol of induction chemoradiotherapy followed by surgery. All studies were performed on third-generation or fourth-generation scanners. Radiographic response was determined using Eastern Cooperative Oncology Group solid tumor response criteria for bidimensional measurable disease. This was compared with the pathologic tumor response. CT-tumor (T) classification using the modified Tio scale was compared with the pathologic T classification. RESULTS: CT-T classification did not correlate with the pathologic stage (P = 0.09) or the pathologic tumor response (P = 0.22). The postinduction chemoradiotherapy CT accurately staged the T classification in 42% of patients but overstaged 36% of patients and understaged 20% of patients. CT had a sensitivity of 65%, a specificity of 33%, a positive predictive value of 58%, and a negative predictive value of 41% in evaluating the pathologic tumor response. CONCLUSIONS: CT is a poor diagnostic study tool for determining the pathologic tumor response or the pathologic disease stage after induction chemoradiotherapy in patients with esophageal carcinoma.     

Value of CT criteria in predicting survival in patients with potentially resectable pancreatic head carcinoma

BACKGROUND AND OBJECTIVE: Survival is often poor after resection of pancreatic tumors. We correlated the pre-operative CTs with survival to find criteria that have prognostic value. To establish the prognostic value of CT in patients with potentially resectable pancreatic head carcinoma. METHODS: In 71 consecutive patients with potentially resectable pancreatic head carcinoma, prognostic factors on CT were scored, for example, tumor size, peripancreatic infiltration, grades of vascular encasement, and local irresectability. All patients underwent surgical exploration. CT findings were compared with results of surgery and histopathology. Prognostic factors for resected and unresected tumors were analyzed using single and multivariate analysis. RESULTS: Forty-one of 71 tumors were resected (24 radical). The sensitivity, specificity, and positive predictive value of CT for surgical irresectability were 0.67, 0.63, and 0.57, respectively. For a non-radical resection, these were 0.62, 0.75, and 0.83, respectively. The median survival was 21 months for resectable tumors and 9.7 months for unresectable tumors. For resected tumors, a tumor diameter of > 3 cm (relative hazard 3.8) and CT signs of local unresectability showed a poor survival. The median survival of resected tumors <2 cm was nearly 30 months. CONCLUSION: CT signs of local irresectability and a tumor diameter of >3 cm predict a poor survival after resection.     

肿块型胰腺淋巴瘤的CT诊断及鉴别

目的 分析肿块型胰腺淋巴瘤的CT表现,以提高诊断水平.方法 回顾性分析9例经病理或临床随访证实的肿块型胰腺淋巴瘤的CT和临床资料.结果 9例肿瘤均为单发,位于胰头部5例、颈体部3例、尾部1例;呈不规则分叶状7例,椭圆形2例;最大径约2.3～7.6 cm,平均4.9 cm.CT平扫肿瘤边界欠清,呈等或略低密度,CT值平均36.5 HU.增强扫描动脉期轻度强化,静脉期呈轻或中度持续强化,7例均匀强化,2例强化不均.5例肿瘤包绕邻近血管,类似“血管漂浮征”.所有肿瘤未见钙化,未见明显胰管增宽,2例出现胆总管轻度增宽.腹腔或腹膜后多发肿大淋巴结6例,增强较均匀一致,中等强化.结论 CT对肿块型胰腺淋巴瘤的诊断及鉴别具有较大价值.     

Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: A systematic review and meta-analysis

ObjectivesComputed tomography (CT) is the most widely used method to assess resectability of pancreatic and peri-ampullary cancer. One of the contra-indications for curative resection is the presence of extra-regional lymph node metastases. This meta-analysis investigates the accuracy of CT in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer.MethodsWe systematically reviewed the literature according to the PRISMA guidelines. Studies reporting on CT assessment of extra-regional lymph nodes in patients undergoing pancreatoduodenectomy were included. Data on baseline characteristics, CT-investigations and histopathological outcomes were extracted. Diagnostic accuracy, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity were calculated for individual studies and pooled data.ResultsAfter screening, 4 cohort studies reporting on CT-findings and histopathological outcome in 157 patients with pancreatic or peri-ampullary cancer were included. Overall, diagnostic accuracy, specificity and NPV varied from 63 to 81, 80–100% and 67–90% respectively. However, PPV and sensitivity ranged from 0 to 100% and 0–38%. Pooled sensitivity, specificity, PPV and NPV were 25%, 86%, 28% and 84% respectively.ConclusionsCT has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer. Therefore, suspicion of extra-regional lymph node metastases on CT alone should not be considered a contra-indication for exploration.     

胰腺CT灌注扫描在胰腺癌生物学行为评估中的价值

背景与目的：胰腺癌预后极差。本研究旨在探讨胰腺CT灌注扫描在胰腺癌肿瘤生物学行为评估中的价值。方法：收集用灌注CT进行诊断的胰腺癌78例,对比正常胰腺及胰腺癌组织血流量(blood flow,BF)、血容量(blood volume,BV)、渗透性(permeability,per),峰值(peak value,PE)及达峰时间(time to peak,TTP)等参数的差别,并结合临床、病理资料对比分析癌组织各灌注参数水平与反映肿瘤生物学行为指标间的关系。结果：78例胰腺癌组织的BF值、BV值、per值及PE值均较周围正常胰腺组织显著减低。血清CA199升高及肿瘤组织CA199表达阳性者BF值明显高于正常者;组织Ki-67阳性者PE值显著高于阴性者;组织CEA阳性者TTP值显著低于阴性者;高分化胰腺癌组织Per值显著高于中、低分化者。结论：胰腺灌注CT扫描在判断胰腺癌肿瘤生物学行为方面有应用前景。     

Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer

Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.     

18F-FDG PET/CT联合血清肿瘤标志物对肺部病变的诊断价值

目的:评估18F-FDG PET/CT联合血清肿瘤标志物对肺部病变的诊断价值。方法:回顾性分析2013年9月至2016年1月因肺部病变在本院行18F-FDG PET/CT显像,并在显像2周内行血清肿瘤标志物细胞角蛋白19片段（CYFRA21-1）、神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）检测的135例患者的临床资料,比较PET/CT和血清肿瘤标志物对肺部病变的诊断价值。结果:在灵敏性、准确性和阴性预测值方面,PET/CT的诊断价值明显高于单项血清肿瘤标志物及其联合组（P=0.000）。在特异性方面,PET/CT的诊断价值低于CEA（P<0.05）,与其他各组比较无明显统计学差异（P>0.05）。在阳性预测值方面,PET/CT与各血清肿瘤标志物之间无明显统计学差异（P>0.05）。结论:18F-FDG PET/CT具有很高的灵敏度,而血清肿瘤标志物特异度较高,因此,将二者结合进行综合分析有助于提高18F-FDG PET/CT的诊断信心和准确率。