多层螺旋CT曲面重建技术显示胰腺癌对胰腺内和胰周管道结构的侵犯

目的探讨应用多层螺旋CT(MSCT)曲面重建(CPR)技术显示胰腺癌侵犯胰腺内和胰周主要管道结构的价值。方法收集胰腺癌侵犯胰腺内和胰周主要管道结构患者37例,对MSCT双期扫描图像行CPR,着重观察胰周主要动脉、静脉、胆管和胰管的形态变化及其与癌灶的关系。结果(1)侵犯胰周动脉28例,受累动脉包括腹腔干、脾动脉、肝总动脉和肠系膜上动脉。动脉受累征象包括:癌灶与动脉之间脂肪间隙消失且包绕动脉大于180度,动脉狭窄或变形,脾梗塞。(2)侵犯胰周静脉31例,受累静脉包括门静脉、脾静脉和肠系膜上静脉。静脉受累征象包括:癌灶包埋静脉,静脉狭窄或变形;静脉节段不显示;静脉内癌栓;特征性的侧支循环形成;脾大。(3)侵犯胆管或胰管18例,表现为胆管、胰管突然中断;胆管、胰管狭窄;癌灶近端胆管、胰管扩张。CPR图像能清晰显示胰腺肿块与受侵管道关系的全貌。结论胰腺癌侵犯胰腺内和胰周主要管道结构可出现相应的MSCT征象。CPR技术对胰腺癌的定性诊断和评价相应管道结构受侵情况有重要价值。

Curved planar reformations in multi-slice spiral CT in pancreatic adenocarcinoma: prediction of invasion of pancreatic and peripancreatic ductal structures

Objective To investigate the clinical values of the curved planar reformation (CPR) in multi-slice spiral CT (MSCT)in determining the malignant invasion of pancreatic carcinoma into the intrapancreatic and peripancreatic ductal structures. Methods Thirty-seven patients having documented pancreatic carcinoma with tumor involvement of intrapancreatic or peripancreatic ductal structures were enrolled. All patients received dual-phase MSCT scan of upper abdomen. Images generated by CPR technique were used for evaluating the appearances of intrapancreatic and peripancreatic ductal structures. Results Malignant invasion of peripancreatic arteries was found in 28 patients and characterized by:obliteration of fat plane between tumor and the artery,with contact surface of more than 180 o; stenosis or deformation of the artery; and infarction of the spleen. Invasion of peripancreatic veins was found in 31 patients and characterized by:tumor encasement of the vein,resulting in the narrowing or deformation of the vein; lack of enhancement of the involved venous segment; tumor thrombosis in the venous lumen; and formation of collateral circulation. Invasion of intrapancreatic segment of the common bile duct or pancreatic duct was found in 18 patients and characterized by:sudden interruption of the bile duct or pancreatic duct; narrowing of the bile duct or pancreatic duct; and dilation of the up-stream ducts proximal to the involvement portion. CPR images clearly depicted the direct relationship between tumor mass and the involved ductal structures. Conclusion Invasion of intrapancreatic or peripancreatic ductal structures by pancreatic carcinoma has certain MSCT imaging features. CPR technique is valuable in depicting these imaging findings.