胰腺癌侵犯胰周主要血管的CT诊断标准探讨  

The CT diagnostic criteria for peripancreatic vascular invasion in pancreatic carcinoma

作　　者：李卉 曾蒙苏[1] 周康荣 丁皓[2] 靳大勇[2] 楼文晖[2] 陈刚 殷允娟 

机构地区：[1]复旦大学附属中山医院放射科上海市影像医学研究所,上海市200032 [2]复旦大学附属中山医院普外科上海市影像医学研究所,上海市200032

出　　处：《中华肝胆外科杂志》2004年第12期817-820,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨多层螺旋CT(MSCT)胰腺检查,胰腺癌侵犯胰周主要血管的CT诊断标准,以期提高判断的敏感性和特异性。方法MSCT检查诊断为胰腺癌的72例病人中,37例行手术治疗,13例行胰十二指肠切除术,24例剖腹探查发现不可切除,病理结果均证实为胰腺导管细胞癌。术中由手术者仔细探查胰周主要血管(肠系膜上动脉、腹腔干、肝动脉、肠系膜上静脉及门静脉主干)。结果肿瘤包绕血管超过管周一半作为判断胰周主要血管受侵的标准,对动脉受侵的敏感性和特异性分别为929%(13/14)和90%(72/80),对静脉为571%(20/35)和100%(35/35);管壁呈浸润性改变作为标准,判断动脉受侵的敏感性和特异性为357%(5/14)和988%(79/80),静脉为629%(22/35)和100%(35/35);管腔狭窄作为标准,对动、静脉受侵判断的敏感性分别为143%(2/12)和657%(23/35),特异性均为100%。动脉被肿瘤包埋、静脉管腔闭塞,血管均为受侵。结论CT须以不同的判断标准来诊断胰周主要动、静脉受侵与否。动脉受侵的判断标准为动脉被肿瘤包埋,或(1)肿瘤包绕动脉大于管周一半,且同时出现(2)管壁浸润或(3)管腔狭窄;而静脉受侵的判断标准为静脉管腔闭塞,或①肿瘤包绕静脉大于管周一半,②管壁浸润,③管腔狭窄,具备三者表现之一,即判为静脉受侵。Objective To study the multislice spiral CT (MSCT) diagnostic criteria for peripancreatic vascular invasion in pancreatic carcinoma. Methods In 72 patients with pancreatic carcinoma examined by MSCT, 37 patients were confirmed by surgery-pathology. A part of patients (n=13) underwent pancraticoduodenectomy, the others (n=24) were found that the tumors were unresectable because the peripancreatic major vessels (including superior mesenteric artery、celiac artery、hepatic artery、superior mesenteric vein and portal vein) were invaded by tumors during surgical exploration. Results With tumor involvement of exceeding one-half circumference of the vessels as the criteria for peripancreatic vascular invasion, the sensitivity and specificity of arterial invasion were 92.9%(13/14) and 90 %(72/80) respectively, those of venous invasion were 57.1%(20/35) and 100%(35/35). With vascular wall irregularity owing to infiltration as the criteria, those of arterial invasion were 35.7%(5/14) and 98.8%(79/80), those of venous invasion were 62.9%(22/35) and 100%(35/35). With vascular caliber stenosis as the criteria, the sensitivity of arterial and venous invasion was 14.3%(2/12) and 65.7%(23/35), specificity of both was 100%. When the arteries were embedded in tumors or the veins were obliterated, they were definitely invaded. Conclusion It is recommended that the CT diagnostic criteria for peripancreatic major arterial and venous invasion should be differently dealt with. The criteria of arterial invasion was the arterial embedded in tumor, or the combination of ①tumor involvement of exceeding one-half arterial circumference with ②arterial wall irregularity or with ③arterial caliber stenosis; that of venous invasion was the venous obliteration, or presence of one of following three findings: ①tumor involvement of exceeding one-half venous circumference ②venous wall irregularity ③venous caliber stenosis.

关 键 词：静脉 肿瘤 血管 动脉 胰腺癌 诊断 管腔狭窄 特异性 包埋 发现 

分 类 号：R735.9[医药卫生—肿瘤] R816.7[医药卫生—临床医学]