CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值

目的探讨CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。方法回顾性分析沈阳军区总医院普外科2013年1月至2014年1月间收治的92例手术治疗的胰腺占位患者资料。患者术前均行CA19-9检查、腹部增强MRI扫描及全身PET/CT扫描,以术后病理或临床综合评价诊断为标准,比较CA19-9、增强MRI和PET/CT在胰腺癌诊断及分期中的价值。结果 92例患者中,确诊胰腺癌82例,非胰腺癌10例。CA19-9检查、腹部增强MRI及全身PET/CT对胰腺癌诊断的灵敏度分别为78.0%、86.6%和92.7%。PET/CT具有较高灵敏度,显著优于CA19-9,差异有统计学意义（P=0.008）;PET/CT优于增强MRI,差异无统计学意义（P=0.200）;在胰周淋巴结转移判断方面,增强MRI和PET/CT的灵敏度分别为46.9%、81.6%,二者差异有统计学意义（P〈0.001）;在肝转移判断方面,增强MRI和PET/CT诊断的灵敏度分别为54.5%、72.7%,二者差异无统计学意义（P=0.66）。结论PET/CT对胰腺癌诊断有较高灵敏度,优于CA19-9、增强MRI;PET/CT有助于发现淋巴结和远处器官转移病灶,获得更加准确的术前分期,从而避免诊断性剖腹探查手术。由于仍然存在假阴性、假阳性,应该综合其他检查方法对疾病作全面分析来提高临床诊断准确性。

Clinical Value of CA19-9, Contrast-enhanced MRI and PET-CT in the Diagnosis and Staging of Pancreatic Cancer

Objective To investigate the CA19-9, enhanced MRI and PET-CT value in the diagnosis and staging of pancreatic cancer. Methods A retrospective analysis of 92 patients with pancreatic placeholder admitted in our hospital was carried out. Preoperative CA19-9 inspection, abdominal enhanced MRI scans and whole body PET-CT scan were performed. The clinical value of CA19-9, enhanced MRI and PET-CT in the diagnosis and staging of pancreatic cancer were evaluated. Results Among 92 patients, 82 cases were diagnosed with pancreatic cancer and 10 cases with non-pancreatic cancer. The sensitivity of CA19-9 inspection, abdominal enhanced MRI and whole body PET-CT for the diagnosis of pancreatic cancer were 78.0%, 86.6% and 92.7% respectively. PET-CT had a higher sensitivity and better than CA19-9 （P 〈 0.01）. PET-CT was superior to enhanced MRI but no statistically significant （P = 0. 200）. The sensitivity of enhanced MRI and PET-CT in the judgment of peripancreatic lymph node metastasis were 46.9% and 81.6% （P 〈0.001 ）. The sensitivity of enhanced MRI and PET-CT in diagnosis of liver metastases were 54.5% and 72.7% without statistically significant （ P = 0.66）. PET- CT in the diagnosis of pancreatic cancer had a higher sensitivity than CA19-9 and enhanced MRI. Conclusion PET-CT could help to find the lymph nodes and distant organs metastasis, to obtain a more accurate preoperative staging, thus avoiding diagnostic laparotomy exploratory surgery. There is still false negative and false positive result for PET-CT, the comprehensive analysis of all inspection method results should be carried out to improve clinical diagnosis accuracy.