3.0TMRI多期增强扫描术前评估胰腺癌可切除性

目的：探讨3.0T MRI多期增强扫描在胰腺癌可切除性评估中的价值。方法对行3.0T MRI 多期增强扫描并经手术病理证实为胰腺癌的38例患者,分析 MRI图像,观察肿瘤对周围血管及邻近器官侵犯、远处转移和腹膜后淋巴结转移情况,作出能否切除的术前评估;并与手术结果比较。结果38例胰腺癌中,32例位于胰头,4例位于胰体,2例位于胰尾。19例术前 MRI认为肿瘤可切除,实际成功切除17例,可切除的阳性预测值为89.5%。另外19例术前MRI认为无法切除,实际手术探查后发现均无法切除。不可手术切除的主要原因包括胰周主要血管受侵、肝转移、淋巴结转移及腹膜种植转移。结论 MRI多期增强在胰腺癌可切除性评估中具有重要价值,可为临床选择合适的治疗方案提供参考依据。     

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。     

螺旋CT双期增强扫描对胰腺癌的诊断价值探讨

目的：探讨螺旋CT双期增强扫描在胰腺癌诊断中的价值。方法：对50例胰腺癌患者行螺旋CT双期增强扫描，比较平扫及增强情况并对图像进行分析研究。结果：50例肿瘤位于胰头部34例，胰体部11例，胰尾部5例。平扫肿瘤呈等密度或略低密度。增强后呈相对低密度。结论：螺旋CT双期增强扫描是诊断胰腺癌的理想检查手段，对判断肿瘤侵犯血管程度和能否手术切除的敏感性具有重要诊断价值。     

螺旋CT双期增强扫描在胰腺癌诊断中的价值

目的探讨螺旋CT双期增强扫描在胰腺癌诊断中的价值。方法31例胰腺癌患者均行螺旋CT双期增强扫描,扫描延迟时间分别定为30s(胰腺期)和70s(门脉期),造影剂用量100mL(非离子型),高压注射器团注,速率2.5mL/s～3mL/s。观察并比较肿瘤及正常胰腺在两期的增强情况。根据CT征象对肿瘤可切除性进行评价,并与手术结果比较。结果31例中肿瘤位于胰头颈部19例,钩突部9例,体部3例。发现小胰腺癌3例,直径均小于2cm。肿瘤一胰腺对比胰腺期与门脉期相比有显著性差异(P<0.01)。胰腺期肿瘤增强后呈相对低密度,为特征性CT表现。胰周大血管受侵占不可切除性肿瘤的占62%,胰周小静脉迂曲扩张占32%,肝脏、淋巴结转移灶占38%。结论螺旋CT双期增强扫描对胰腺癌的诊断及可切除性评价具有非常重要的临床价值。     

多层螺旋CT对胰腺癌的术前评估

目的:探讨多层螺旋CT双期增强扫描及图像后处理在胰腺癌手术可切除性研究中的应用价值。方法:对63例胰腺癌患者进行MSCT双期增强薄层横断位扫描,结合多平面重组(MPR)、最大密度投影(MIP)、三维容积演示(VR)等后处理技术,对胰腺癌作出能否切除的术前评估,并以手术结果作为对照和分析。结果:35例患者进行了手术,19例MSCT认为可切除的,实际术中切除15例(可切除率79%);16例MSCT认为不可切除的,实际术中不可切除15例(不可切除率94%)。结论:MSCT对胰腺癌术前可切除性的评估具有重要的临床指导意义。     

螺旋CT多期扫描技术对胰腺癌的诊断价值

目的：探讨螺旋CT多期扫描对胰腺癌的诊断价值。方法：搜集行SCT动脉期、胰腺期、肝脏期三期扫描的胰腺肿块75例，均经手术病理证实，其中胰腺癌53例，局限性胰腺炎22例，比较肿瘤与炎症在SCT增强扫描各期中的表现。结果：本组胰腺癌53例，其中胰头癌33例，胰颈癌4例、胰体癌14例，胰尾癌2例。局限性胰腺炎22例，头、颈、体、尾分别为17例、2例、2例、1例。增强扫描，动脉期胰腺癌低密度43例，等密度10例，胰腺炎低密度2例，等密度20例；胰腺期胰腺癌低密度51例，等密度2例，胰腺炎低密度1例，等密度21例；肝脏期胰腺癌低密度42例，等密度11例；胰腺炎22例均为等密度。结论：胰腺螺旋CT动脉期、胰腺期、肝脏期三期增强扫描在胰腺癌诊断中具有非常重要的临床价值。     

螺旋CT在胰腺癌诊断中的价值及临床应用

目的：探讨螺旋CT在胰腺癌中的诊断价值及临床应用。方法：回顾性分析了48例胰腺癌患者螺旋CT图像，扫描时间为注射对比剂后40－55s和60s左右，并依照正常胰腺组织和肿瘤在平扫和两期的增强情况、CT征象行术前评估，再与手术结果对照。结果：胰腺－肿瘤增强密度差异值平均分别为胰腺期49.10HU、门静脉期27.0HU，两期差异有显著意义（t=2.543、P＜0.01)。肿块在胰腺期能够清晰显示。25例术前认为可切除的肿瘤，术中仍有7例不能切除。结论：螺旋CT双期扫描能够明显提高胰腺癌的诊断准确率并为临床提供有价值的术前评估。     

螺旋CT三期增强扫描及后处理对胰腺癌的诊断及术前分期的价值

目的 探讨螺旋CT三期增强扫描及后处理对胰腺癌的诊断价值及手术可切除性的评估.方法 回顾分析41例胰腺癌的螺旋CT三期增强及后处理图像资料,分析肿瘤的部位、大小、强化特征和胰周血管是否受侵等,并与手术结果对照.结果 胰腺癌灶在胰腺期较门脉期强化程度低,病灶与正常胰腺组织问密度差别大,病变显示清晰;与手术结果对比,螺旋CT三期增强及后处理对胰周动脉受侵评价的准确度为80.7%,对转移评价的准确度为75.8%.结论 螺旋CT三期增强及后处理对胰腺癌的诊断有重要价值,有助于术前治疗方案的选择和可切除性的评估.     

螺旋CT双期增强扫描在小胰腺癌诊断中的应用

目的　研究螺旋CT胰腺期、门脉期双期增强扫描在小胰腺癌早期诊断和正确分期中的作用。方法　对14例小胰腺癌患者行螺旋CT双期增强扫描,扫描延迟时间分别为30s和65s,对比剂用量100ml,注射速度3ml/s。观察并比较正常胰腺及肿瘤在两期的增强情况。根据CT征象对肿瘤可切除性进行评价,并与手术结果比较。结果　肿瘤-胰腺对比胰腺期和门脉期分别为(47.08±20.39)HU和(28.77±16.23)HU（t=2.533,P<0.01）。14例肿瘤中,术前认为可以切除11例,术中切除9例。结论　螺旋CT双期增强扫描能更清晰地显示小胰腺癌,胰腺期肿瘤-胰腺对比较门脉期更显著,有利于小胰腺癌的早期诊断和可切除性的判断。     

多层螺旋CT血管成像对胰腺癌侵犯胰周血管的表现及可切除性评价

目的：评价多层螺旋CT血管成像（MSCTA）检查对胰腺癌侵犯胰周主要血管的影像表现及手术可切除性评价。方法：使用16层螺旋CT对胰腺癌患者扫描后,进行动脉期和门脉期胰周主要血管CTA三维成像。以三维图像为主,结合原始图像对胰周血管是否受累进行判别及评价,并与手术对照。结果：51例手术病例与手术结果比较,术前MSCTA判断不能切除的21例中手术均无法切除,术前MSCTA判断能切除的30例中手术结果能切除28例,2例误判,判断符合率为93%。结论：MSCTA对于胰腺癌术前可切除性评估具有重要的临床意义。     

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     

胰腺癌的可切除性评价(经动脉双期螺旋CT与血管造影的对比分析)

分别采用经动脉双期螺旋ＣＴ扫描和选择性血管造影,对胰腺癌的可切除性进行术前前瞻性评价,以确定各自的临床应用价值。方法对１５例胰腺癌术前均行选择性造影及经动脉增强双期螺旋ＣＴ扫描,对胰腺癌的临床应用价值。结论经动脉双期螺旋ＣＴ扫描弥补了血管造影的不足,能够更为准确,全面地评价胰腺癌的可切除术,具有较高的临床应用价值。     

Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery

OBJECTIVE: The aim of our study was to prospectively evaluate the accuracy of dual-phase helical CT in the preoperative assessment of resectability in patients with suspected pancreatic cancer using surgical and histopathologic correlation. SUBJECTS AND METHODS: Between January 1999 and December 2000, 76 patients with suspected pancreatic cancer underwent preoperative evaluation and staging with dual-phase helical CT (3-mm collimation for pancreatic phase, 5-mm collimation for portal phase). Iodinated contrast material was injected IV (170 mL at a rate of 4 mL/sec); acquisition began at 40 sec during the pancreatic phase and at 70 sec during the portal phase. Three radiologists prospectively evaluated the imaging findings to determine the presence of pancreatic tumor and signs of unresectability (liver metastasis, vascular encasement, or regional lymph nodes metastasis). The degree of tumor-vessel contiguity was recorded for each patient (no contiguity with tumor, contiguity of < 50%, or contiguity of > or =50%). RESULTS: Thirty-nine patients with pancreatic adenocarcinoma were surgically explored. Curative resections were attempted in 34 patients and were successful in 25. The positive predictive value for resectability was 73.5%. Nine patients considered resectable on the basis of CT findings were found to be unresectable at surgery because of liver metastasis (n = 5), vascular encasement (n = 2), or lymph node metastasis (n = 2). We found that the overall accuracy of helical CT as a tool for determining whether a pancreatic adenocarcinoma was resectable was 77% (30/39 patients). CONCLUSION: Dual-phase helical CT is a useful technique for preoperative staging of pancreatic cancer. The main limitation of CT is that it may not reveal small hepatic metastases.     

胃癌螺旋CT术前评估及与手术病理分期对照研究

目的:应用螺旋CT行胃癌术前评估,并将CT分期与手术病理分期进行比较。方法:98例胃癌患者术前行腹部螺旋CT检查,并实施手术分期和病理分期。结果:所有患者行手术治疗,其中16例(16%)无法切除,82例(84%)手术切除。CT扫描中胃壁的厚度和浆膜的累及有相关性(P<0.001)。CT和手术预测病理分期的符合率分别为68%和52%。CT过度分期只有17%。结论:螺旋CT是胃癌患者术前检查的一种有效的方法,可预测胃癌病灶的可切除性,从而避免某些不必要的剖腹手术或使手术方案更加合理。CT过度分期的概率较低,其分期的准确率高于手术。     

Malignant biliary obstruction: efficacy of thin-section dynamic CT in determining resectability.

OBJECTIVE. Several authorities advocate the use of preoperative angiography to determine the resectability of pancreatic and periampullary tumors, claiming that CT alone is not sufficiently accurate for this purpose. Our objective was to assess the value of CT in predicting surgical resectability in patients with malignant biliary obstruction. MATERIALS AND METHODS. We performed a retrospective analysis of 380 consecutive cases of malignant biliary obstruction spanning a 4-year period. Most patients (230) were treated nonoperatively. Sixty-seven patients had surgery, pathologic confirmation of malignancy, and preoperative CT scans available for review. The CT scans were assessed for surgical resectability of tumor by an interpreter who did not know the patient's history. RESULTS. Forty-two patients had pancreatic adenocarcinoma, six had ampullary carcinoma, seven had cholangiocarcinoma, and 12 had other malignant neoplasms. Of 47 patients with tumors thought to be unresectable on the basis of CT findings, 42 had tumors that were found to be unresectable at surgery (positive predictive value, 89%). Of 20 patients with tumors thought to be resectable, 16 had tumors that were surgically resectable (positive predictive value, 80%). CT did not show metastases to duodenal lymph nodes (n = 2), portal vein infiltration (n = 1), and small hepatic metastases (n = 1). Visualization of most of these at angiography would not be expected. The CT finding of infiltration of the periarterial fat around the celiac or superior mesenteric arteries was reliable for predicting surgical unresectability. Lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability. CONCLUSION. Although some findings on CT that suggest unresectability are less reliable than others, the accuracy of CT compares favorably with reports on the accuracy of angiography for assessing tumor resectability in cases of malignant biliary obstruction. The addition of angiography to the examination of patients with potentially resectable lesions is not justified when high-quality, thin-section dynamic CT has been performed.     

Endoscopic ultrasound and Computed Tomography in the diagnosis, locoregional staging and assessment of vascular infiltration of pancreatic carcinoma

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of colour-Doppler Endoscopic Ultrasonography (EUS), in the detection, loco-regional staging and assessment of vascular infiltration in pancreatic carcinoma, and to compare the results with those obtained by Computed Tomography (CT). MATERIALS AND METHODS: A series of 57 patients with diagnosed or suspected pancreatic carcinoma was retrospectively analysed. All patients underwent EUS and thin-slice (< 5 mm) spiral dynamic CT. The final diagnosis (carcinoma in 37 patients and benign lesion in 20) was obtained by laparotomy in 21 patients, fine-needle aspiration cytology (FNAC) in 17, and follow-up in 19. RESULTS: The specificity and sensitivity for the diagnosis of malignancy were respectively 45% and 92% for EUS and 45% and 89% for CT, with an accuracy of 75% for EUS (p <0.05) and 74% for CT (p = 0.07). The specificity and sensitivity for the diagnosis of loco-regional nodal metastases were both 100% for EUS. The specificity and sensitivity for the diagnosis of vascular infiltration were 100% and 94% for EUS and 100% and 44% for CT, giving a diagnostic accuracy of 97% for EUS vs 74% for CT (p <0.001). CONCLUSIONS: EUS proved to be more sensitive and specific than CT in the loco-regional staging of pancreatic carcinoma. Its diagnostic accuracy is especially high in assessing vascular infiltration and loco-regional nodal metastases. CT still remains the examination of choice for staging pancreatic carcinoma and for assessing its resectability as it affords a panoramic view and ability to rule out distant metastases. Candidates to resection should all be examined by EUS, as, due to its high accuracy in loco-regional staging and assessing vascular infiltration, it might allow a large proportion of patients to be spared the operation.     

胰腺影像学检查进展

影像学技术的发展极大地促进了胰腺影像诊断水平的提高。本文回顾了螺旋CT和多层面CT、MR成像、ERCP、超声成像和介入放射学技术的进展，及其在胰腺疾病检查中的应用与常见胰腺疾病的影像学表现。多项影像学检查方法和技术的综合应用胰腺影像诊断领域的趋势。     

The usefulness of spiral Computed Tomography and colour-Doppler ultrasonography to predict portal-mesenteric trunk involvement in pancreatic cancer

PURPOSE: The aim of this study was to determine the clinical utility of spiral computed tomography (CT) and colour Doppler ultrasonography (US) in the evaluation of portal-mesenteric trunk (PMT) involvement in pancreatic cancer. MATERIALS AND METHODS: Ninety-five patients with pancreatic cancer underwent preoperative assessment of the PMT with spiral CT and colour Doppler US. Five stages of vascular involvement were established. During surgery intraoperative US was performed to confirm the preoperative findings. RESULTS: Of the 95 patients observed, 82 (86.3%) underwent surgery. The sensitivity of spiral CT was 98%, specificity 79%, overall accuracy 80.2%. The positive predictive value was 87.5%; the negative predictive value 96%. The results of colour Doppler US were 92.3%, 72,7%, 72.8%, 79.5% and 88.8%, respectively. CONCLUSIONS: The results indicate that spiral CT is the gold standard in detecting PMT involvement in pancreatic cancer. Colour Doppler US is useful, but adds nothing to CT. Both of these techniques improve the possibility of predicting the resectability of pancreatic cancer.