胰腺癌CT征象及手术切除性估价的探讨（附67例分析）

分析了６７例经手术及病理学证实的胰腺癌的ＣＴ征象。胰腺轮廓局限性增大５０例（７４．６％），８例（１１．９％）显示向肠系膜侵犯的线条状影，等密度或均匀低密度病灶４１例（６１．２％）。受累血管以下腔静脉、肠系膜上动、静脉及腹主动脉为多（９４．８％）。脾脏增大１５例，继发假性囊肿１１例。讨论了早期胰腺癌诊断的难点和可能性，总结了胰腺癌继发囊肿的ＣＴ特征，对胰腺癌手术切除性的ＣＴ标准进行了评估。     

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。     

胰腺癌CT诊断难点的探讨

笔者总结了经ＣＴ扫描及病理证实的胰腺癌共１２０例，其中直径≤３ｃｍ的小胰癌９例，癌肿全部位于胰头；以囊性肿块为主要表现的胰腺癌１０例。重点讨论了小胰腺癌及囊性胰腺癌的ＣＴ诊断。小胰腺癌的直接征象主要为胰腺轮廓外形改变，胰头不规则，轻度增大或有小的局部隆起，钩突圆隆增大。间接征象主要为胰、胆管的梗阻扩张。注射造影剂应用１．５～３ｍｍ薄层连续动态扫描，可使小的癌肿呈低密度改变，早较早发现小胰腺癌的有效     

胰腺癌的CT诊断及其与B超的对比研究

目的：研究胰腺癌胰周组织侵犯征象，提高ＣＴ术前分期的诊断准确率。并为诊断胰腺癌提供合理选用ＣＴ、Ｂ－ＵＳ的依据。材料与方法：总结６４例经手术、病理证实的胰腺癌，对术前ＣＴ、Ｂ－ＵＳ的诊断准确率及各种征象检出率进行对比，并进行回顾性分析。结果ＣＴ、Ｂ－ＵＳ的诊断准确率，直接及间接征象、部分胰周侵犯、肝转移征象的检出率相似。ＣＴ在胆总管阻塞端，胰周大血管侵犯，腹膜后淋巴结转移的检出率优于Ｂ－ＵＳ。结论     

肝总动脉瓣膜状闭塞

目的：正确认识肝总动脉瓣膜单方面闭塞并探讨其介入治疗肝癌的临床价值。材料与方法：肝总动脉闭塞伴胰动脉弓侧支供养肝脏的患者１７例，行肠系膜上动脉或胰十二指肠下动脉造影以了解有无肝总动脉瓣膜状闭塞。结果：１２例患者肝总动脉呈瓣膜状闭塞，即腹腔动脉造影时肝总动脉完全闭塞，肠系膜上动脉或胰十二指肠下动脉造影时，肝总动脉“闭塞段”血流通畅，类似静脉瓣状。结论：肝总动脉瓣膜状闭塞与多次介入治疗、肝癌切除＋术中     

胃癌手术切除可能性的CT研究

目的：为了能在手术前对胃癌病变的侵犯范围、大小、程度进行较准确的估计，避免盲目剖腹手术不能切除病变给患者造成不必要的痛苦和经济负担。方法：对６０例胃癌术前ＣＴ表现进行前瞻研究，ＣＴ检查方法强调口服温开水作对比剂静脉团注增强扫描。根据ＣＴ表现将本组病例分为可手术组和不宜手术组，与手术病理进行对照。结果：可手术组的切除率为９５％，不宜手术组的手术切除率仅１２．５％，两者差异极显著（Ｐ＜０．０１）。结论：进展期胃癌不能手术切除的ＣＴ指征是：（１）胃癌发生远处转移（如肝、腹膜等）；（２）胃癌直接侵犯周围脏器（如肝左叶、胰腺等）；（３）ＣＴ显示有腹腔动脉、腹主动脉及肠系膜动脉周围淋巴结转移     

电子束CT双期扫描定量估价胰腺增强程度

目的：定量估价电子束ＣＴ双期扫描胰腺的增强程度。材料和方法：１１０例可疑胰腺病变者（２６～７２岁）均行电子束ＣＴ检查。其中胰腺癌１５例，胰腺炎３例，胰腺外伤２例，正常胰腺９０例。应用高压注射器以３．５ｍｌ／秒（８０ｍｌ）和１０ｍｌ／秒（２０ｍｌ）速度注射Ｕｌｔｒａｖｉｓｔ１００ｍｌ，在注射造影剂后１８～２０秒和５５～６０秒，应用ＳＶＳ０．３秒序列扫描胰腺２０层，层厚６ｍｍ。于动静脉期测量胰腺头、体、尾ＣＴ值。结果：在动脉期胰腺增强的ＣＴ值为１０１Ｈｕ±８（标准差），静脉期为８１Ｈｕ±５。其中６１例（５５％）动脉期较静脉期ＣＴ值增高２０Ｈｕ以上；３８例（３４％）增高１０Ｈｕ以上；１１例（１０％）动脉期ＣＴ值低于静脉期。结论：胰腺动脉期扫描较静脉期可提供更详细的解剖结构，可更清楚显示胰腺癌对胰周的浸润，可提高检测胰腺内小病灶的准确性。     

薄层动态CT对胰腺癌的早期诊断

笔者采用薄层动态ＣＴ扫描，诊断直径≤３ｃｍ的胰腺癌１２例，其直接征象为胰头轻度不规则增大或有小的局部隆起、钩突圆隆变形、胰腺实质的分叶形态消失；间接征象为胰管、胆管的梗阻性扩张。认为薄层动态ＣＴ扫描是早期胰腺癌诊断的有效方法。     

胰腺癌与慢性胰腺炎的CT诊断

目的：提高对胰腺疾病的ＣＴ诊断水平。材料与方法：作者根据被证实的１５４例胰腺癌、慢性胰腺炎及其他疑误诊为前两种疾病病例的ＣＴ资料，对４５个项目，３８个ＣＴ征象进行观测、统计与分析。结果：二者诊断与鉴别的主要征象是：（１）病变区胰腺局限或弥漫肿大与密度异常；（２）有无扩张的胆总管（或壶腹）突然性狭窄截断与胰周大血管被包埋、管径增粗、癌栓，腹部淋巴结肿大、肝转移；（３）有无沿胰管走向分布的钙化与扩张胰管，扩张胰管的形态与贯通病变区的情况；（４）胰腺囊肿的发生频率、部位，与胰腺的轮廓关系。结论：根据前述要点，参考其他征象，密切结合临床，ＣＴ诊断正确率达９０％以上。     

64层螺旋CT检查对胰腺癌治疗的指导价值

目的:探讨胰腺癌的64层螺旋CT(容积CT/VCT)表现与临床的关系及对手术的指导价值。方法:回顾分析了35例经病理证实的胰腺癌,利用VCT的直接、间接征象以及临床表现,评估手术价值,分析检查技术的应用与病变检出率的关系。结果:35例中,动脉期检出33例(94%),门静脉期为28例(80%);胰头癌25例(71.4%),胰体癌8例(22.9%),胰尾癌2例(5.7%)。病灶直径在2.7~15 cm之间,直径小于3 cm的13例,其中囊腺癌4例。35例术前评估可手术切除18例,实际切除15例;17例不可切除。VCT评估可切除的准确率为83.3%,不可切除的准确率为100%。结论:VCT能较好地检出小于3 cm的小胰腺癌,尤其是CT血管成像可以直观显示肿瘤与周围结构的关系及血管受侵情况,在肿瘤分期及评估可切除与不可切除上具有较高价值。     

胰腺癌侵犯胰周主要血管的CT表现分析

目 的分析多层螺旋CT(MSCT)胰腺检查，胰腺癌侵及胰周主要动、静脉的不同CT表现特征。方法 MSCT诊断胰腺癌68例患者中，33例行手术治疗(其中12例行胰十二指肠切除术，21例剖腹探查发现不可切除)，病理结果均证实为胰腺导管细胞癌。术中由手术者仔细探查胰周主要血管[肠系膜上动脉(SMA)、腹腔干(CA)、肝动脉(HA)、肠系膜上静脉(SMV)及门静脉主干(PV)]。结果 165支受检血管中，手术探查发现103支血管未受侵犯，其余62支血管受侵，MSCT术前检查，8．1％(5／62)受侵血管误判为未受侵犯(假阴性)。其余受侵的胰周主要动、静脉(57支)具有不同的CT表现特征：胰周主要动脉受侵时，均被肿瘤包绕大于管周的1／2或完全包埋于肿瘤中。胰周主要静脉受侵时，部分静脉血管被肿瘤包绕小于管周的1／2：SMV为4支(4／17)，PV为2支(2／13)，但同时均出现管壁受浸润或管腔狭窄或管腔形态改变；胰周静脉受侵犯时出现管腔狭窄或闭塞的机会较胰周动脉大：SMV为11支(11／17)，PV为12支(12／13)，而CA为3支(3／8)，HA为4支(4／7)，SMA为4支(4／12)；胰周静脉受侵犯时管壁呈浸润性改变的比例较胰周动脉高：SMV为11支(11／17)，PV为7支(7／13)，而CA为3支(3／8)，HA为2支(2／7)，SMA为6支(6／12)。结论 胰周动、静脉受侵及时，其CT表现具有不同特征。     

Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT

PURPOSE: To assess the value of arterial, pancreatic, and hepatic phase imaging at multi-detector row computed tomography (CT) of the pancreas for pancreatic malignancy. MATERIALS AND METHODS: Thirty-nine patients suspected of having resectable pancreatic adenocarcinoma underwent triple-phase multi-detector row CT. Images obtained during each phase were interpreted by one radiologist who evaluated presence of tumor, vascular invasion, and flow artifacts in the superior mesenteric vein and measured attenuation of tumor, normal pancreas, aorta, and superior mesenteric vein. Results were compared with histologic, follow-up, and correlative imaging findings. RESULTS: Mean tumor-to-gland attenuation difference was greatest on images obtained in the pancreatic phase (42 HU) versus that on those obtained in the hepatic phase (35 HU) and in the arterial phase (25 HU). For tumor detection, sensitivity of the images obtained in pancreatic (0.97 [29 of 30]) and hepatic (0.93 [28 of 30]) phases was superior to that of those obtained in arterial phase (0.63 [19 of 30]) (P < or =.008). For vascular invasion detection, sensitivity of images obtained in the hepatic phase (0.83) was better than that of those obtained in the pancreatic (0.58) and arterial (0.25) phases. Images obtained in the pancreatic phase demonstrated more flow artifacts and decreased attenuation in the superior mesenteric vein, compared with the artifacts revealed on images obtained in the hepatic phase. CONCLUSION: Routine acquisition of images in the arterial phase is unnecessary for detection of pancreatic adenocarcinoma. Images of the pancreas obtained in the hepatic phase with multi-detector row CT most accurately display vascular invasion.     

Role of multi-detector computed tomography in the evaluation of pancreatic tumors

Objective

The purpose of this study was to determine the role of multidetector computed tomography (MDCT) in evaluation and prediction of pancreatic tumors resectability.

Patients and methods

The study included 20 patients who had pancreatic masses, 16 males and 4 females, and their age range was 30–70 years with a mean age of 58.0 years. All the patients underwent non-contrast and contrast enhanced Multi-slice CT using a 16-slice machine. The gold standard for diagnosis was histopathology and operative data.

Results

Adenocarcinoma as reported by pathological studies was found in 8 patients, cyst adenocarcinoma in one patient, infiltrative adenocarcinoma in 2 patients, intraductal papillary mucinous tumor in 2 patients, mucinous cyst adenocarcinoma in one patient, pancreatic pseudo cyst in 2 patients and mucinous cystadenoma in 4 patients. According to MDCT criteria 6 patients were considered suitable for tumor resection and 14 patients were considered inoperable with unresectable tumor, one out of the 6 operable patients was unresectable during operation due to the invasion of the superior mesenteric vein with infiltration of the mesenteric root.

Conclusion

Contrast-enhanced multiphase pancreatic imaging by multislice computerized tomography (MSCT) with its postprocessing techniques represents the image of choice for diagnosis and predicting pancreatic masses and resectability.     

Extrapancreatic neural plexus invasion by carcinomas of the pancreatic head region: evaluation using thin-section helical CT

Purpose The aim of this study was to determine the computed tomographic (CT) criteria for diagnosing the second portion of the extrapancreatic neural plexus (PLX-II) invasion by carcinoma of the pancreatic head region on thin-section helical CT. Materials and methods A total of 41 patients with carcinoma of the pancreatic head region (17 in the pancreas, 24 in the lower common bile duct) underwent three-phase helical CT (collimation 5 mm; reconstruction 2.5 mm) before surgery. Two criteria were established for the assessment of the PLX-II running between the superior mesenteric artery (SMA) and the medial margin of the uncinate process: criterion A: assessment of the area around the SMA and inferior pancreaticoduodenal artery; criterion B: assessment of the jejunal trunk. Results PLX-II invasion was pathologically confirmed in 19 patients with pancreatobiliary carcinoma. For criterion A, all 19 patients with positive PLX-II invasion and 20 of the 22 with negative PLX-II invasion were correctly diagnosed (sensitivity 100%; specificity 91%; accuracy 95%). For criterion B, 3 of the 17 patients with positive PLX-II invasion and all 20 with negative PLX-II invasion were correctly diagnosed (sensitivity 18%; specificity 100%; accuracy 62%). The two false-positive cases using criterion A were correctly diagnosed using criterion B. Conclusion Thin-section helical CT provides sufficient diagnostic ability regarding PLX-II invasion by carcinoma of the pancreatic head region.     

多层螺旋CT肠系膜血管成像的临床应用

目的:探讨多层螺旋CT肠系膜血管成像(MMSCTA)的临床应用价值。方法:对32例经证实的肠系膜血管病变患者进行多层螺旋CT(MSCT)检查,采用多种后处理技术(VR、MIP、MPR、CPR)进行肠系膜血管成像,观察肠系膜血管病变的情况。结果:32例患者中,肠系膜上动脉(SMA)栓塞2例,MMSCTA及DSA示SMA充盈缺损;SMA血栓形成1例,MMSCTA及DSA示SMA主干呈长条状充盈缺损;肠系膜上静脉(SMV)栓塞9例,MMSCTA示SMV充盈缺损7例,2例不显影;胰腺癌侵犯SMA、SMV者13例,MMSCTA示肠系膜血管被包埋,血管狭窄中断;SMA主干或分支狭窄伴软斑形成7例。结论:多层螺旋CT肠系膜血管成像是肠系膜血管病变的一种无创性有价值的检查方法。     

螺旋CT双期增强对胰腺癌病人的术前评估

目的 探讨螺旋CT双期增强对胰腺癌可切除性术前评估的价值。方法 对1999年5月～2003年3月期问行螺旋CT双期增强扫的45例诊断为胰腺癌病人的CT图像与22例手术结果进行对比研究，通过显示胰腺癌的部位、大小以及肿块对周围血管侵犯程度、远处器官转移以及后腹膜淋巴结转移，作出能否切除的术前评价。结果 45例胰腺癌病人中18例位于胰头，16例位于胰体尾，11例位于胰尾；27例患接受手术治疗，其中22例术前SCT认为肿瘤可切除，实际成功切除17例，成功切除的阳性预测值达77％，其他5例SCT认为肿瘤不能切除，实际手术均不能切除。结论 螺旋CT双期增强扫描可作为一种评价胰腺癌术前能否手术切除的有效方法。     

急性肠系膜上动脉血栓形成的螺旋CT诊断

目的:分析急性肠系膜上动脉血栓形成的临床特点及螺旋CT表现,提高认识水平.方法:回顾性分析7例经手术证实为肠系膜上动脉血栓形成的螺旋CT表现.7例均行平扫加增强扫描,及最大密度投影图像后处理重建.结果:7例增强均显示肠系膜上动脉血栓形成的直接征象为肠系膜上动脉管腔充盈缺损.螺旋CT平扫5例出现肠系膜上动脉密度增高,4例肠系膜上静脉与肠系膜上动脉管径比例<1,4例肠系膜上动脉壁斑片状钙化,2例肠腔淤积扩张,2例薄纸样肠壁及腹腔积液等征象.7例最大密度投影重建显示肠系膜上动脉血管内不同程度充盈缺损、管腔狭窄.结论:螺旋CT检查对于早期诊断肠系膜上动脉血栓形成是一种有价值的方法.对于不明原因所致腹痛及临床怀疑肠系膜缺血的患者均应及时行螺旋CT检查.     

Percutaneous irreversible electroporation of surgically unresectable pancreatic cancer: a case report

The present report describes a case of percutaneous irreversible electroporation (IRE) in a 78-year-old man with surgically unresectable stage III (tumor/node/metastasis stages, T4N0M0) pancreatic adenocarcinoma. Two ablations were performed for a 4.1-cm mass encasing the celiac and superior mesenteric artery. At 3 months, a solitary liver metastasis developed, which was treated with radiofrequency ablation followed by gemcitabine chemotherapy. At 6-month follow-up, magnetic resonance imaging demonstrated no residual disease and a decreasing cancer antigen 19-9 level. Percutaneous IRE shows promise as a feasible and potentially safe method for local tumor control in patients with surgically unresectable disease.     

胰腺及胰周血管强化的多层螺旋CT研究

目的　探讨多层螺旋CT增强扫描胰腺及胰周血管强化的最佳时相及扫描方案。资料与方法　采用多层螺旋CT对 19例胰腺正常的患者行动脉期、胰腺期及门脉期三期扫描 ,比较胰腺、肠系膜上动脉 (SMA)和肠系膜上静脉 (SMV)在三期图像上的强化程度 ,以及观察胰周小血管的充盈显影情况。结果　胰腺期胰腺强化程度最大 ,高于动脉期和门脉期 (P <0 .0 0 1)。SMA于动脉期强化程度最大 ,其次为胰腺期 ,两者差别无统计学意义 (P >0 .0 5 ) ,但两者均高于门脉期 (P <0 .0 0 1)。SMV于胰腺期强化程度最大 ,高于动脉期和门脉期 (P <0 .0 5 )。胰腺期胰周小动脉和小静脉均能得到较好充盈显影。结论　胰腺及胰周血管在胰腺期获得最大程度强化和充盈显影 ,胰腺CT增强扫描最佳扫描方案为胰腺期和门脉期双期扫描。如需行CTA时 ,多层螺旋CT可行三期扫描     

Teardrop superior mesenteric vein: CT sign for unresectable carcinoma of the pancreas

OBJECTIVE: Our objective was to investigate whether a tethered, teardrop-shaped superior mesenteric vein (SMV) is a reliable CT indicator of unresectable adenocarcinoma of the head of the pancreas. MATERIALS AND METHODS: CT scans of 92 patients with high suspicion for pancreatic head adenocarcinoma were retrospectively reviewed by two radiologists who were unfamiliar with the patients' outcomes. The reviewers were asked to assess whether the teardrop SMV sign was present or not; agreement was reached by consensus. Teardrop SMV was considered absent in patients with an obstructed vessel. RESULTS: Of 92 patients, 30 had a normal pancreas without a teardrop SMV. A mass in the head of the pancreas was seen in all 62 patients with cancer. Of these 62 patients, 30 (seven with teardrop SMV) were deemed to have inoperable disease by standard CT or clinical criteria. The remaining 32 patients underwent surgery; only 15 of these 32 had successful pancreatoduodenectomies. No patient with resectable tumor had an unequivocal teardrop SMV sign. In 17 patients (13 with teardrop SMV), resection of the tumor could not be accomplished because of vascular encasement (n = 12) or metastasis (n = 5). Added to conventional signs, teardrop SMV significantly increased CT's sensitivity (from 60% to 91%) and accuracy (from 79% to 95%) without significantly changing its specificity (from 100% to 98%) for resectability of pancreatic head cancer. CONCLUSION: The teardrop SMV is a reliable sign for predicting unresectability of adenocarcinoma of the head of the pancreas and can significantly contribute to preoperative planning.