CT与MRI对胰岛素瘤定位诊断的比较研究

目的:比较CT与MRI对于胰岛素瘤定位诊断的临床价值.资料和方法:2006-09～2009-12临床疑诊胰岛素瘤患者共28名,均接受CT和MRI检查.以手术病理及临床定性诊断为对照标准,对比分析两种检查方式对胰岛素瘤的定位诊断效能.结果:19名患者经手术病理证实胰岛素瘤19例,其中CT检出12例,MRI检出16例.9名临床定性诊断除外胰岛素瘤的患者CT和MRI检查均为阴性.CT对胰岛素瘤术前定位诊断的敏感度、特异度、阳性预测值及阴性预测值分别为63.2%(12/19)、100%(9/9)、100%(12/12)及56.3%(9/16),MRI上述数值分别为84.2%(16/19)、100%(9/9)、100%(16/16)及75%(9/12).两种检查方法对胰岛素瘤定位诊断敏感度、阴性预测值间的差异无统计学意义(P=0.1336,P=0.4343).结论:CT和MRI对胰岛素瘤定位诊断的价值无明显差异.     

胰岛素瘤的超声诊断与其他诊断方法比较

胰岛素瘤占胰腺内分泌肿瘤的80%～85%[1,2],其临床表现多种多样,常伴有神经精神系统的症状,影像学检查常不易发现,很容易误诊误治.80年代以来随着B超仪器的改进和高频探头的出现,术中超声(IOUS)应用于临床.自1982年Lane等[3]首先报道IOUS用于探测胰岛素瘤以来,相继有不少成功的报道.本文报道我院从1985-2006年26例经手术治疗、病理证实的胰岛素瘤,现将其术前术中定位诊断和超声引导手术切除情况报告如下.     

动脉内钙剂刺激试验在功能性胰岛素瘤术前定位中的应用

目的:评价动脉内钙剂刺激试验在功能性胰岛素瘤术前定位诊断中的作用。方法:对10例胰岛素瘤患者行动脉内钙剂刺激肝静脉采血试验(ASVS)测定胰岛素的研究,ASVS前均行超声、CT、MRI及内镜超声检查。10例功能性胰岛素瘤均得到手术病理证实,病灶大小为0．8-2．0 cm。分别行胃十二指肠动脉(GDA)、肠系膜上动脉(SMA)、脾动脉近端(sAP)和脾动脉远端(SAD)造影,并通过导管注射钙剂5 m1(含Ca2 约27 mg),于每次动脉刺激后30、60、90、120、 150和180 s行右肝静脉取血测定胰岛素:不同动脉激发试验的间隔时间为15 min。阳性判断标准:若胰岛素峰值达到或超过基础值的4倍以上,即提示该动脉为肿瘤的供血动脉,肿瘤即被定位于相对应的胰腺区域。结果:10例中9例ASVS 结果与最终诊断完全一致,1例肿瘤位于胰尾,因未行SAD激发而漏诊。结论:ASVS是功能性胰岛素瘤安全、准确的术前定位方法,尤其适用于病灶较小、其他影像学检查结果为阴性的病例。     

经动脉钙剂刺激试验术前定位诊断胰岛素瘤的价值

目的：评价经动脉钙剂刺激试验对胰岛素瘤术前定位的诊断作用。方法：对16例临床颖为胰岛素胰腺B超和CT检查均阴性的患者，术前应用经动脉钙剂刺激肝静脉取血测定胰岛素（ASVS）的方法进行肿瘤定位。经各供胰动脉分别注射葡萄糖酸钙，在注射前及注射后30，60，90，120，150s分别取2ml肝静脉血测定胰岛素。动脉刺激后血胰岛素水平的峰值超过基础值2倍以上，则确定肿瘤位于该动脉供应的胰腺区域，结果：16例患者，手术和病理证实孤立胰岛素瘤12例和胰岛细胞增生1例，除1例胰岛素瘤外，ASVS对肿瘤均做出了准确定位，另3例经手术探查或随访排除胰岛素瘤，ASVS结果亦为阴性。因此ASVS术前定位胰岛素瘤或胰岛细胞增生的敏性为92．3％（12／13），特异性为100％（3／3），准确性为93．7％（15／16）。结论：经动脉钙剂刺激肝静脉取血测定胰岛素的方法安全准确，适用于其他影像学检查阴性的胰岛素瘤的术前定位。     

256层螺旋CT双期增强扫描对胰岛素瘤的诊断价值

目的应用256层螺旋CT双期增强扫描分析总结胰岛素瘤的CT影像特点,评估双期增强扫描对胰岛素瘤的定位诊断价值。方法随机选取临床疑诊胰岛素瘤患者30例,行CT扫描,以手术后病理及临床定性诊断为对照标准,分析双期CT增强扫描诊断胰岛素瘤的定位诊断效能,并总结分析胰岛素瘤的CT影像特点。结果 24例经手术病理证实为胰岛素瘤,CT扫描检出22例,6例临床定性诊断除外胰岛素瘤患者CT检查均为阴性。CT对胰岛素瘤术前定位诊断的灵敏度、特异度、诊断符合率分别为:91.67%(22/24)、100%(6/6)、93.33%(28/30)。22例胰岛素瘤均为单发,其中1例为恶性肿瘤,余均为良性;肿瘤位于胰头7例,胰体5例,胰尾10例;肿瘤多较小,边缘光整,最大径为0.60~5.22cm;CT平扫多为等低密度病灶,增强扫描动脉期肿瘤明显强化,静脉期肿瘤强化减退,密度减低。结论胰岛素瘤CT影像表现具有鲜明的特征,应用256层螺旋CT双期增强扫描对胰岛素瘤术前定位诊断具有重要的应用价值。     

动脉钙刺激静脉采血检查术前定位胰岛素瘤的临床价值

目的评价动脉钙刺激静脉采血(ASVS)检查术前定位胰岛素瘤的临床价值。方法对12例临床定性诊断为胰岛素瘤患者术前行ASVS检查,选择性插管至胃十二指肠动脉、肠系膜上动脉、脾动脉近段和远段,分别快速注入葡萄糖酸钙激发,于激发前和激发后30、60、90、120、150和180 s经肝静脉采血测胰岛素值,计算不同激发值与基础值之比值,将比值最高者的动脉所供应的胰腺区域认定为肿瘤所在区域。结果ASVS定位准确性为83.3%,优于经腹超声(33.3%)、内镜超声(42.9%)、CT(75%)、MR(80%)和选择性血管造影(16.7%)。结论ASVS在胰岛素瘤术前定位中准确率高而且安全,尤其适合于其他形态学检查阴性的隐匿型胰岛素瘤。     

胰岛素瘤的影像学评价(附28例报告)

目的：探讨多种影像学方法在胰岛素瘤术前定位诊断中的价值。资料与方法：28例经手术病理证实的胰岛素瘤患者于术前做B超和DSA检查，22例行胰腺CT扫描，10例行MRI检查。结果：4种影像学方法对胰岛素瘤术前定位诊断准确率分别为：DSA 82％（23／28），超声57％（16／28），CT 41％（9／22），MRI90％（9／10）。DSA与超声。MRI相结合使本组术前定位诊断准确率达93％（26／28）。结论：MRI和DSA是胰岛素瘤术前定位诊断准确率高而有效的方法。对临床有Whipple三联征患者，应首先选用超声和MRI或螺旋CT检查，特别是MRI或螺旋CT薄层快速动态增强扫描。当上述无创检查方法仍不能明确诊断时，可进一步行胰血管造影，多种影像技术联合应用可以提高本病的诊断准确率。     

彩色多普勒超声与CT血管成像诊断单中心206例Stanford B型主动脉夹层对照分析北大核心CSCD

目的以CT血管造影(CTA)为诊断金标准,对照分析彩色多普勒超声(CDUS)诊断Stanford B型主动脉夹层(AD)的准确性。方法2017年10月至2021年11月在北京安贞医院经DSA明确诊断的206例Stanford B型AD患者纳入研究。男性153例,女性53例,年龄(55.3±9.3)岁(28~77岁)。DSA术前3 d内完成主动脉及其分支CTA和CDUS检查。以术前CTA诊断分析结果为金标准,探讨CDUS对AD诊断指标的显示率、诊断准确率和漏诊率。CDUS与CTA测量结果对照分析采用配对t检验。结果CDUS诊断B型AD准确率为100%(206/206)。AD双腔显示率100%,内膜片显示率93.2%(192/206),真假腔诊断准确率88.8%(183/206),AD累及范围符合率95.6%(197/206),假腔血栓显示率72.5%(66/91),降主动脉原发破口显示率68.9%(142/206),远端再破口显示率64.6%(360/557),内脏分支(肾动脉、肠系膜上动脉、腹腔干动脉)受累形式符合率83.7%~100%,内脏分支(肾动脉、肠系膜上动脉、下肢动脉)灌注不良诊断符合率100%(17/17、9/9、3/3)。降主动脉原发破口大小、原发破口距左锁骨下动脉开口距离、主动脉各节段最宽处管腔内径、真腔内径、假腔内径与CTA测量值对照差异无统计学意义(均P>0.05)。结论CDUS是一种快速、简单诊断Stanford B型AD的方法,可与CTA良好匹配。     

CT、B超对妇科盆腔肿瘤的诊断价值

目的:探讨CT、B超在妇科盆腔肿瘤诊断中的应用价值。方法:回顾性分析132例经手术及病理证实 的妇科盆腔肿瘤的CT、B超资料。结果:132例妇科盆腔肿瘤,CT符合率为89.4%,B超符合率为87.9%;121例 盆腔肿瘤定性诊断:CT符合率为88.4%,B超符合率为87.6%;28例盆腔恶性肿瘤分期:CT符合率为82.1%(23/ 28),B超符合率为75%(21/28);11例术后复发盆腔肿瘤:CT11例均与病理相符,B超10例相符,1例漏诊。结 论:CT、B超对妇科盆腔肿瘤的诊断具有重要的价值,合理应用能更好地指导临床治疗和术后疗效观察。     

原发性胆囊癌的影像学诊断(附52例分析)

目的:探讨超声、CT和MRI在胆囊癌诊断中的临床应用价值。方法:回顾性分析52例经手术及病理证实的胆囊癌的超声、CT和MRI资料。结果:52例胆囊癌术前超声诊断符合率为73.1%(38/52),CT诊断符合率为75%(39/52),MRI符合率为83.3%(15/18)。其中合并慢性胆囊炎伴胆囊结石21例(40.4%)。影像表现为4种类型:胆囊壁增厚型(16例),乳头结节型(15例),混合型(壁厚和结节8例),实体型(13例)。结论:超声、CT和MRI对胆囊癌的诊断具有重要的临床价值,合理的应用能更好地指导临床治疗和术后疗效观察。     

Intraarterial calcium stimulation (ASVS) for pancreatic insulinoma: comparison of preoperative localization procedures

PURPOSE: Evaluation of clinical relevance of the arterial stimulation procedure with venous sampling (ASVS) in the preoperative localization of insulinoma. METHODS: Thirteen patients with endogenous hyperinsulinism underwent preoperative transabdominal ultrasound (US), helical CT (CT), MRI, endoscopic ultrasound (EUS), and angiography (DSA) in conjunction with the ASVS-test for the detection of insulinoma. The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histology. RESULTS: Sensitivity was as follows: US 8%, MRI 27%, CT 46%, EUS 50%,DSA 69%,and ASVS 92%. Intraoperative palpation and IOUS yielded a sensitivity of 77%. In 3 patients the tumors were neither palpable nor detectable by IOUS, the mode of resection was based on preoperative diagnostics. The ASVS procedure as a functional test was superior to all other modalities for the preoperative tumor detection. CONCLUSION: The ASVS was the most sensitive diagnostic modality. It should especially be considered in terms of health economical aspects when CT or MRI do not yield conclusive results.     

Role of the intra-arterial calcium stimulation test in the preoperative localization of insulinomas

The aim of this study was determination of the significance of the arterial stimulation test with venous sampling (ASVS) in the preoperative localization of insulinoma. Eleven patients with endogenous hyperinsulinism underwent preoperative transabdominal US, spiral computer tomography (spiral CT), MRI, endoscopic ultrasound (EUS) as well as angiography (DSA) combined with ASVS. The results were compared with intraoperative findings, intraoperative ultrasound (IOUS) and histopathology. There were no complications related to the ASVS test. In 11 patients the tumor could be localized with the various modalities as follows: US 1 of 11 (9 %), MRI 3 of 10 (30 %), spiral CT 4 of 11 (36 %), EUS 5 of 10 (50 %), DSA 8 of 11 (73 %), and ASVS 10 of 11 (91 %). In 2 patients the tumors were intraoperatively neither palpable nor detectable by IOUS, and consequently the intraoperative management was governed by information provided by DSA combined with the ASVS test. Ten patients had solitary benign insulinomas and 1 patient with multiple endocrine neoplasia I had two tumors adjacent to each other in the pancreatic tail. Arterial stimulation test with venous sampling was the most sensitive preoperative test for regionalizing the insulinoma in our set of patients. It can be performed safely in the course of a regular DSA examination and may affect intra-operative management in patients in whom the tumors are not detectable by palpation or IOUS. Received: 23 June 1999; Revised: 13 January 2000; Accepted: 29 February 2000     

The role of arterial stimulation and simultaneous venous sampling in addition to cross-sectional imaging for localisation of biochemically proven insulinoma

Insulinomas, although rare, cause considerable morbidity but are frequently amenable to surgical cure. Laparoscopic surgery can now be considered if the tumour is localised pre-operatively, but the optimal imaging approach has not been determined. The objective of this study was to evaluate the ability of different imaging investigations, including CT, MRI, endoscopic ultrasound, octreotide scintigraphy and arterial stimulation with simultaneous venous sampling (ASVS), to localise insulinomas. All patients with biochemically proven insulinoma at our institution underwent ASVS along with other imaging investigations as part of their routine investigation. The results of these investigations were compared with histological findings. Twenty-eight patients with biochemically proven insulinoma confirmed by histology were identified. Ultimately ASVS localised a lesion in all patients. Seventeen patients (61%) had laparoscopic surgery. Tumor-detection rates for other imaging investigations included 43.5% of cases using CT, 71% using MRI, 86% using endoscopic ultrasound and 33% using octreotide scintigraphy. In four patients, the ASVS was the only test to correctly localise the lesion. ASVS should be considered routinely before surgery to ensure accurate localisation of insulinomas.     

Selective arterial calcium stimulation and hepatic venous sampling in the evaluation of hyperinsulinemic hypoglycemia: potential and limitations

PURPOSE: To describe the potential and limitations of selective arterial calcium stimulation and hepatic venous sampling (ASVS) in the evaluation of patients with hyperinsulinemic hypoglycemia. MATERIALS AND METHODS: Twenty-seven consecutive adult patients with documented hyperinsulinemic hypoglycemia undergoing an ASVS test and histologically confirmed diagnosis were included. RESULTS: By histology, 24 patients were found to have an insulinoma, two had islet cell hyperplasia, and one had insulin-secreting neuroendocrine carcinoma of the liver. ASVS correctly predicted the source of excessive insulin secretion in 26 of 27 (sensitivity, 96%) patients. In two patients with an insulinoma, ASVS had to be repeated for correct diagnosis; in one patient with a glucose-sensitive insulinoma, ASVS was falsely negative. In one patient, a falsely negative ASVS test was caused by diazoxide treatment; in another patient a falsely negative ASVS test occurred because of extraordinarily high baseline insulin levels when the calcium stimulation was performed. CT and/or MR imaging correctly predicted the source of excessive insulin secretion in 59% of patients, the sensitivity of the intraoperative exploration was 88%. CONCLUSIONS: In the authors' experience, the ASVS test is superior to CT/MR imaging and even the intraoperative exploration in identifying the source of excessive insulin secretion in patients with hyperinsulinemic hypoglycemia. To prevent false negative ASVS tests, medications with an influence on insulin secretion have to be discontinued prior to ASVS and two baseline blood samples should be obtained before the calcium stimulation is performed.     

Endoscopic ultrasonography for demonstrating loss of multiple-layer pattern of the thickened gallbladder wall in the preoperative diagnosis of gallbladder cancer

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer. Received 29 July 1996; Revision received 27 November 1996; Accepted 21 January 1997     

Invasive Diagnostik bei Insulinomen des Pankreas

Insulinomas are the most common cause for hypoglycemia with endogenous hyperinsulinism. Insulinomas are the most frequent endocrine tumor of the pancreas and 10% occur as multiple tumors (e.g. multiple endocrine neoplasia type I) or in rare cases as islet cell hyperplasia. A further 10–15% of insulinomas are malignant. Non-invasive imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and somatoreceptor scintigraphy (SRN) show a lower sensitivity for detection and localization of tumors, because in many cases insulinomas are smaller than 2 cm in size. Invasive pre-operative diagnostic procedures, such as transhepatic peripancreatic venous blood sampling (TPVB) and the intra-arterial calcium stimulation test (ASVS) are much more time-intensive compared to CT, MRI and US with an examination time of 2-3 h but achieve a more exact pre-operative detection and localization with sensitivities mostly greater than 95% and are therefore the diagnostic methods of choice.