胰腺癌侵犯胰周主要血管的MSCT表现及手术可切除性评价  

The MSCT characteristics of peripancreatic vascular invasion and resectability in pancreatic carcinoma

作　　者：张琳[1] 叶强[1] 

机构地区：[1]同济大学附属第十人民医院放射科,上海200072

出　　处：《同济大学学报（医学版）》2007年第6期81-85,117,共6页Journal of Tongji University(Medical Science)

基　　金：上海市科委基金资助项目(034119841)

摘　　要：目的评价多排螺旋CT(Mutislice Spiral Computed Tomography)检查,胰腺癌胰周主要血管侵犯情况的MSCT表现及与手术可切除性分析。方法对临床诊断或病理证实为胰腺癌的患者52例(其中20例行手术治疗),行横断位三期增强扫描,观察肿瘤侵犯胰周主要血管的MSCT表现,并与术中探查结果进行一致性比较。结果受侵犯主要胰周动、静脉(肠系膜上动脉、腹腔干、肝动脉、肠系膜上静脉及门静脉主干)具有不同的MSCT表现特征:受侵胰周静脉易出现管腔狭窄或闭塞,多呈现为偏心性狭窄或一侧变平,部分静脉包绕管周小于1/2;侵犯胰周动脉时不常出现狭窄,可表现为向心性狭窄,且包绕管径大于3/4及以上,呈包埋趋势(29/34);静脉较动脉更易出现管腔内壁的毛糙,特别是当肿瘤包绕管径小于1/2时;本组38例(38/44)胰周静脉受侵犯时,致胰周相应小静脉迂曲、扩张。20例手术病例与手术结果比较,阳性预测值、阴性预测值分别为95%(19/20),100%(80/80)。结论动、静脉受侵时具有不同的表现特点,MSCT对于胰腺癌术前可切除性评估具有重要的临床意义。Objective To evaluate various characteristics of MSCT signs of peripancreatic arterial and venous invasion in pancreatic carcinoma and resectability of the pancreatic carcinoma. Methods Fifty-two patients with pancreatic malignancy confirmed by clinical diagnose or pathologic examinations （including 20 patients were treated by surgery） underwent tri-phase MSCT combined with MSCTA. CT signs of peripancreatic main vascular invasions were observed. Results The characteristics of invaded peripancreatic major vessels were as follows： the peripancreatic major veins more often behaved vascular stenosis or obliteration than peripancreatic major arteries, especially behaving eccentricity stenosis or flatten, parts of which were involved by tumor above onehalf circumference of the vessels; the peripancreatic major arteries did not often behave stenosis, which may behaved centripetal stenosis and involved by tumor above three-quarter circumference of the vessels or embedded intumor（29/34） ;The invaded peri-pancreatic veins were more often behaved wall irregularity than the invaded arteries, especially when involved by tumor below one-half circumference of the vessels; The invaded peri-pancreatic veins, were always visualized the abnormally dilated peri-pancreatic small veins（38/44 patients）. Among 20 confirmed by surgical pathology, the positive predictive value and negative predictive value were 95 % （ 19/ 20）, 100 % （80/80） respectively. Conclusion The MSCT signs of peripancreatic have different characteristics between arterial and venous invasion. MSCT may be useful in predicting resectability of pancreatic carcinoma.

关 键 词：胰腺肿瘤 体层摄影术 X线计算机 血管造影 

分 类 号：R81[医药卫生—放射医学]