胰腺癌胰周血管受侵的MSCT表现及可切除性评估

目的探讨胰腺癌胰周血管受侵的MSCT表现及与手术结果的比较。方法 80例胰腺癌患者(后经临床综合诊断或病理证实)行MSCT三期增强扫描及三维重组。根据重建图像结合横断位图像对胰周主要血管进行识别。胰周主要血管包括腹腔动脉(CA),肠系膜上动脉(SMA),脾动脉(SA);门静脉(PV),脾静脉(SV),肠系膜上静脉(SMV)。将胰腺癌与血管的关系分为0～4级。评价270条胰周主要血管的影像资料,并与手术结果对照,分别计算各分级敏感性、特异性、阳性预测值及阴性预测值和准确率。结果不同部位、不同大小的肿瘤侵犯的胰周血管及其程度各不相同,随着MSCT分级的增高,对于胰腺癌手术可切除性判断的敏感性逐渐降低,而特异性逐渐升高。对于手术可切除性判断的敏感性、特异性均较高的MSCT影像分级是2级。结论多层螺旋CT胰周血管成像提高了胰腺癌的早期诊断率及手术可切除性判断的准确率。

The MSCT characteristics of peripancreatic vascular invasion and respectability evaluation in pancreatic carcinoma

Objective To investigate various MSCT signs of vessels invasion of pancreatic carcinoma and then compare it with surgical results.Methods Eighty patients with pancreatic carcinoma thereafter confirmed by clinical signs or pathologic examinations（including 45 patients treated by surgery） underwent tri-phase MSCT combined with MSCTA.Peripancreatic vessels include celiac artery（CA）,superior mesenteric artery（SMA）,splenic artery（SA）,portal vein（PV）,splenic vein（SV）,superior mesenteric vein（SMV）.The invasion states were devided into 0～4 grades.To evaluate the imaging of 270 peripancreatic vessels,and then correlated it with surgical results.To calculate the sensitivity,specificity,positive prognostic value,negtive prognostic value and accurate rate of each grade.Results The invasion of peripancreatic vessels and its invasion degree were different from the tumor＇s location and it＇s size.The sensitivity decreased by the increasing of the grade,but the specificity increased by the increasing of the grade.Using grade two as the resection standard of pancreatic cancer,the sensitivity and specificity were higher.Conclusion MSCTA improves the ability to predict the resectability of pancreatic carcinomas.