能谱CT对胰腺癌可切除性的评估

目的 探讨能谱CT成像对胰腺癌术前可切除性评估的临床应用价值.方法 对46例经手术病理证实的胰腺癌患者进行能谱CT扫描.应用能谱CT综合评价癌肿与周围主要血管、脏器的关系及肝脏、腹腔淋巴结转移情况.结果 能谱CT术前正确判断8例存在肝转移,11例存在淋巴结转移.经统计学分析,能谱CT评估动脉受侵的特异性为98.9％,敏感性为95.2％;评估静脉受侵的特异性为100％,敏感性为90.6％;判断总体血管受侵的特异性为99.2％,敏感性为93.5％.结论 能谱CT可准确判断胰腺癌是否发生肝转移和淋巴结转移,并可提高对胰周血管是否受侵判断的特异性和敏感性.     

螺旋CT双期扫描对胰腺癌可切除性的评价

目的 评价螺旋ＣＴ双期扫描对胰腺癌可切除性的价值。材料与方法 对４２例拟诊胰腺癌随后又行手术治疗的患者作出前瞻性的诊断和可切除性的评估。病理结果：胰腺癌３３例,非胰腺癌９例。ＣＴ双期延迟扫描时间分别为２５ｓ和６０ｓ。并将ＣＴ判断的结果与手术结果作对比。结果 ４２例中,螺旋ＣＴ正确诊断３９例（９３％）。螺旋ＣＴ判断可切除性的敏感性为８９％,牧场划性为９２％,准确性为９１％。１０例肝转移癌,ＣＴ诊断８     

螺旋CT双期扫描对胰腺癌可切除性的评估

目的 :探讨螺旋CT双期扫描 (SPCT)对胰腺癌可切除性术前评估的价值。方法 :经病理证实的胰腺癌 5 2例 ,对其术前可切除性进行评估 ,采用CT双期扫描方法 ,时间为动脉期 (AP)延迟 2 5s ,门静脉期 (PVP)延迟 6 5s ,以 3～ 4ml/s团注造影剂 80～ 10 0ml后扫描。结果 :SPCT判断可切除 9例 ,手术证实5例可切除 ,4例不可切除。可切除性阳性预测值 (NPV)为 5 5 6 %。SPCT判定不可切除 4 3例 ,手术证实不可切除 4 1例 ,可切除 2例 ,不可切除性阳性预测值 (PPV) 95 3%。结论 :SPCT术前对胰腺癌不可切除的判断准确率高 ,可作为临床放弃手术治疗较可靠的依据 ;但对可切除性的判定准确率较低 ,故选择手术治疗前必须十分谨慎 ,以减少不必要的开腹手术。     

多层螺旋CT对胰腺癌周围血管侵犯及肿瘤可切除性的术前评估

【摘要】目的：探讨术前CT对胰腺癌周围血管侵犯和肿瘤可切除性的评估价值。方法：回顾性分析经病理证实的98例胰腺癌的CT多期增强表现,根据其胰周血管侵犯情况及胰腺癌可切除标准,将所有病例分为可切除组、潜在可切除组和不可切除组。以手术及病理结果作为金标准,评价CT对胰腺癌周围血管的诊断效能及肿瘤可切除性的诊断符合率。结果：98例胰腺癌中,术前CT诊断可切除组37例,潜在可切除组38例,不可切除组23例。与手术及病理结果对照,CT对胰周动脉受侵的诊断符合率、敏感度、特异度分别为92.2%、89.9%、92.8%;对胰周静脉受侵的诊断符合率、敏感度、特异度分别为96.9%、95.6%、97.3%。术前CT对可切除组、潜在可切除组、不可切除组的诊断符合率分别为为97.3%、86.8%、91.3%。结论：CT多期增强扫描对胰腺癌周围血管受侵情况的评估具有重要价值,有利于术前评估肿瘤的可切除性。     

胰腺癌的CT诊断

本文详细分析了经病理证实的27例胰腺癌和10例相关病倒的CT 表现.胰腺癌的CT 表现为:(1)胰腺内的软组织肿块;(2)肝内、外胆道及胰管的扩张;(3)肿瘤远端胰组织的萎缩;(4)肝、淋巴结的转移.讨论了胰腺癌各种CT 表现的意义和胰腺癌与其他引起与胰腺癌类似的CT 表现的鉴别诊断.     

胰腺癌41例CT影像学特征与其术前可切除性的相关性研究

胰腺癌占全身恶性肿瘤的1%-4%,其发病机制目前尚未明确。胰腺癌早期常无明显的特异性症状,而恶性程度又较高,诊断和治疗较为棘手,本组病例回顾性分析41例胰腺癌，通过影像学表现与临床手术结果相结合，对其影像学特征加以分析总结，为临床手术术式的选择提供参考。     

多层螺旋CT对评价胰腺癌可切除性的作用

目的 探讨多层螺旋CT评价胰腺癌的可切除性，并与手术比较。方法 使用TOSHIBA Aquilion16层螺旋CT，对67例临床胰腺癌患者行动态增强CT扫描，判断胰腺病变大小，评价及判别胰周血管是否受累，观察肝脏及腹膜后淋巴结是否转移，判别胰腺癌的影像学可切除性，结合手术及病理结果，进行统计学分析。结果 CT增强扫描判断胰腺癌可切除性的敏感性72．72％，特异性98．21％。通过卡方检验，x^2=1．000，P〉0．05，胰腺癌可切除性的术前CT判断与外科手术判断在统计学上没有差异。结论 CT判断胰腺癌可切除性对选择手术方式具有前瞻性指导意义。     

MRI对食管癌可切除性的评价

ＭＲＩ对食管癌可切除性的评价马林高元桂梁燕李涛张全亮孙玉鹗早期食管癌外科切除效果较好，对分期不明者，应尽可能术前判断其切除可能性，减少不必要的开胸探查［１，２］。ＭＲＩ评价食管癌可切除性已有报道［３～７］。笔者对２４例食管癌患者进行了术前ＭＲＩ检查，...     

胰腺癌可切除性螺旋CT双期扫描征象与手术结果对比研究

目的：探讨螺旋CT双期扫描对胰腺癌可切除性评估的价值。方法：对41例CT诊断胰腺癌患者与手术及病理结果对照。并回顾性分析胰腺肿瘤导致胰周器官侵犯时手术切除的可能性。结果：手术及病理证实37例为胰腺癌，手术切除14例，其中胰头癌7例(包括1例胆管远端癌)，体尾癌7例。所切除的14例中有Ⅰ期8例，Ⅱ期3例，Ⅲ期2例，Ⅳ期1例。即7例中存在不同程度的周围器官侵犯和转移。结论：①对手术切除性评估不能局限于肿块大小和周围器官是否侵犯，而应根据肿瘤生长部位，形态具体分析；②螺旋CT双期扫描对胰腺癌诊断准确性高，但胰头癌与壶腹部癌及胰头慢性炎症的鉴别有时仍存在一定困难。     

Pancreatic carcinoma: the role of high-resolution multislice spiral CT in the diagnosis and assessment of resectability

The purpose of our study was to evaluate multislice computed tomography (MSCT) in the assessment of patients with clinical, laboratory, and US suspicion of pancreatic neoplasm, and to evaluate resectability status. Forty-six patients with a suspected pancreatic tumor underwent MSCT. After a preliminary precontrast survey, a postcontrast scan was performed in the arterial and portal venous phase with the following protocol: 4×1-mm collimation; 1.25- and 5-mm slice thickness width, respectively, and 1- and 5-mm reconstruction interval. In all patients pathological correlation was obtained. The evaluation of all images provided a diagnosis in 44 patients, with a sensitivity, specificity, and accuracy of 97, 80, and 96%, respectively. The MSCT correctly provided a diagnosis of unresectability with sensitivity of 96%, specificity of 86%, and accuracy of 93%. Evaluation of 1-mm slices demonstrated 83 of the 91 liver metastases found at surgery; conversely, the 5-mm slices detected only 76 of these lesions. Infiltration of peripancreatic major vessels was demonstrated, and was confirmed at surgery in 18 patients. High-resolution MSCT improves prediction of resectability in patients with suspected pancreatic carcinoma. Parenchymal and vascular information can be achieved with a single MSCT examination. Electronic Publication     

Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

Objective

To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst.

Materials and Methods

This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher''s exact test was used to analyze the results.

Results

A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different.

Conclusion

The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.     

The Role of Imaging in Current Treatment Strategies for Pancreatic Adenocarcinoma

In pancreatic cancer, imaging plays an essential role in surveillance, diagnosis, resectability evaluation, and treatment response evaluation. Pancreatic cancer surveillance in high-risk individuals has been attempted using endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI). Imaging diagnosis and resectability evaluation are the most important factors influencing treatment decisions, where computed tomography (CT) is the preferred modality. EUS, MRI, and positron emission tomography play a complementary role to CT. Treatment response evaluation is of increasing clinical importance, especially in patients undergoing neoadjuvant therapy. This review aimed to comprehensively review the role of imaging in relation to the current treatment strategy for pancreatic cancer, including surveillance, diagnosis, evaluation of resectability and treatment response, and prediction of prognosis.     

胰腺癌的CT诊断

目的：探讨胰腺癌的ＣＴ特征、诊断与鉴别诊断。材料和方法：分析５５例（男３９例，女１６例）胰腺癌患者的临床和ＣＴ表现。年龄最大７８岁，最小２８岁，平均５７．７岁。其中胰头部癌３８例（６９．０９％），体部１２例（２１．８２％），尾部５例（９．０９％）。ＣＴ扫描以１０ｍｍ层厚与间隔，自隔顶扫至钩突下缘，胰腺部则取５ｍｍ层厚与间隔。并作冠状面及矢状面重建。结果：５５例中仅２０例手术切除。平均生存期为５～８月。ＣＴ表现为胰腺局部分叶状肿块（５０／５５）；平扫时与周围胰腺组织呈等密度或略低密度：增强后强化不明显，甚至低于正常胰腺组织；胰周组织浸润（２０／５５）；血管受侵（３７／５５）；远处转移（１７／５５）；继发性囊肿（４／５５）。３８例胰头癌ＣＴ中可见胰体、尾萎缩（３４／３８）；胰管扩张（２４／３８）；梗阻性胆管扩张（肝内胆管＋总阻管扩张１５例；单纯肝内胆管扩张４例）。结论：熟悉胰腺癌的特征性与非特征性表现，多数病例可被确诊，但对临床预后无帮助。     

磁共振灌注成像在胰腺癌中的应用初探

探讨磁共振灌注成像在胰腺癌诊断中的应用价值。胰腺癌患者34例,健康志愿者28例,采用VIBE序列进行全胰腺灌注成像,通过胰腺癌和正常胰腺各感兴趣区的时间-信号曲线,计算各感兴趣区的峰值时间(TTP)、最大斜率(SS),比较胰腺癌与正常胰腺的灌注值差别。胰腺癌TTP值为140.24±24.14s、正常胰腺TTP值为24.33±3.74s,两者间有统计学差异(P<0.05);胰腺癌和正常胰腺的SS值分别为16.10±2.20、30.23±4.66,两者间亦有统计学差异(P<0.05)。相对正常胰腺,胰腺癌的TTP显著延长,SS明显降低。磁共振灌注成像可以在活体无创的评估胰腺血供。     

周围型肺腺癌增强CT与血管生成的相关研究

目的　探讨周围型肺腺癌CT增强表现与血管生成的关系。材料与方法　对 2 9例周围型肺腺癌标本进行S P法免疫组织化学染色 ,检测VEGF表达 ,并且用FVⅢ RA标记微血管内皮细胞来检测微血管密度 (MVD)。全部病例CT增强的同时有 17例进行了 3min内的动态CT增强扫描。结果　 2 9例周围型肺腺癌组织中的MVD与血管内皮生长因子 (VEGF)呈正相关 (r=0 .76 ) ,有淋巴结转移组的MVD、VEGF强表达率明显高于无淋巴结转移组(P <0 .0 5 ) ,Ⅱ期组的MVD、VEGF强表达率明显高于Ⅰ期组 (P <0 .0 1) ;其中 17例 3min内的CT增强值与MVD呈正相关 (r=0 .73～ 0 .84 ) ;VEGF强表达组的CT增强值显著高于弱表达组 (P <0 .0 5 )。结论　周围型肺腺癌在3min内的CT增强值与血管生成呈正相关 ,可能反映肺癌的恶性程度     

Pancreatic pseudoaneurysm: CT features

Haemorrhage is a serious and life-threatening complication of pancreatitis. We present a case of bleeding pancreatic pseudoaneurysm in which CT established t the diagnosis. Correspondence to: A. A. Ghiatas     

Resectability of pancreatic tumors: Correlation of multidetector CT with surgical and pathologic results

Purpose

The purpose of this study is to evaluate the ability of multidetector CT (MDCT) in predicting resectability of pancreatic tumors.

Patients and methods

Thirty-nine patients were included in this study, there were 29 males and 10 females, and their age range was 44–73 years with a mean age of 58.3 years. All the patients were subjected to contrast enhanced biphasic examinations on 64-slice CT machine.

Results

Twenty-one patients (53.8%) were considered inoperable with unresected tumor, the remaining 18 patients (46.2%) were considered suitable for tumor resection according to MDCT criteria. 15 out of the 18 patients (83.3) had a successful tumor resection while the remaining 3 (16.7%) showed unresectable tumor during operation. On the basis of pathology results 12 patients out of the 18 (66.7%) had successful surgery with negative tumor margin, and a positive predictive value of 66.7% and accuracy of 66.7%.

Conclusions

There is better prediction of resectability of pancreatic tumors with the development of MDCT technology. As compared to Helical computed tomography (HCT) studies, there is a rise in the rate of successful surgical resection. The positive predictive value of multidetector computed tomography for resectable pancreatic tumors is decreased when pathologic results are used as a reference standard.