不同影像学检查对胰腺癌肿瘤大小及周围组织浸润的前瞻性评估  

Prospective comparison of ultrasonography, helical computed tomography, magnetic resonance imaging, and endoscopic ultrasonography in assessing locoregional invasion of primary pancreatic carcinoma

作　　者：田艳涛[1] 王成锋[1] 赵心明[2] 王贵齐[3] 欧阳汉[2] 郝玉芝[2] 陈雁[2] 张红梅[2] 赵平[1] 

机构地区：[1]中国医学科学院肿瘤医院腹部外科,北京100021 [2]中国医学科学院肿瘤医院影像诊断科,北京100021 [3]中国医学科学院肿瘤医院腔镜室,北京100021

出　　处：《中华肿瘤杂志》2008年第4期270-273,共4页Chinese Journal of Oncology

基　　金：国家“十五”攻关课题资助项目（2004BA703811）;国家教育部高等学校博士学科点专项基金资助项目（20020023024、20030023008、20070023114）

摘　　要：目的前瞻性评估超声（US）、螺旋CT（HCT）、内镜超声（EUS）和核磁共振成像（MRI）在胰腺癌肿瘤大小测量及肿瘤周围组织浸润的预测价值及其ll缶床意义。方法对68例手术治疗的胰腺癌患者术前进行US、HCT、EUS和MRI检查，每种方法均由2位医师对其肿瘤最大径、最小径及肿瘤周围组织浸润情况进行前瞻性评估，并与手术病理结果进行对比。结果在US、HCT、EUS和MRI等4种检查方法中，EUS是评估肿瘤大小最准确的方法，最大径和最小径的回归系数分别为1．0250（P=0．0426）和0．9873（P〈0．0001）。在局部组织侵犯的评估中，EUS准确率（75．8％）和敏感性最高（80．0％），而MRI的阳性预测值（97．4％）最高。单元Logistic回归显示，在胰腺癌局部组织侵犯预测方面，任何一种检查方法与手术病理结果均无相关性（P〉0．05）。结论EUS是评估胰腺癌肿瘤大小最准确的方法，在肿瘤局部组织侵犯预测方面尚需多种方法联合应用。Objective To evaluate prospectively the efficacy and clinical significance of ultrasonography （US）, helical computed tomography （HCT）, endoscopic uhrasonography （EUS） and magnetic resonance imaging （MRI） in assessing locoregional invasion to the surrounding tissue or organs of primary pancreatic carcinoma. Methods Sixty-eight consecutive patients with pancreatic carcinoma underwent US, HCT, EUS and MRI examinations before surgical exploration. All imaging results in terms of tumor size and locoregional invasion were assessed separately by two diagnostic radiologists and compared with the surgical and pathological findings. Results Among the HCT, US, EUS and MRI examinations, EUS had the highest accuracy in assessing tumor size with a regression coefficient for the maximal and minimal diameter of 1. 0250 （ P = 0. 0426 ） and 0.9873 （ P 〈 0. 0001 ） , respectively. In the assessment of locoregional invasion to the surrounding tissue or organs, EUS also had the highest accuracy （75.8%） and sensitivity（80.0% ）, but MRI had the highest positive predicting value （97.4%）. None of these four imaging techniques was significantly correlated with the surgical findings when analyzed by univariate logistic regression. Conclusion Endoscopic uhrasonography may be the most useful imaging technique in assessing tumor size, but for assessing loco-regional invasion of primary pancreatic carcinoma, combination of more than one imaging techniques may be necessary.

关 键 词：胰腺肿瘤 彩色血流多普勒 内镜超声检查 螺旋CT 核磁共振 

分 类 号：R686[医药卫生—骨科学]