不同影像学检查对胰腺癌血管浸润及淋巴结转移的前瞻性评估  

Prospective evaluation of the clinical significance of ultrasonography, helical computed tomography, magnetic resonance imaging and endoscopic uitrasonography in the assessment of vascular invasion and lymph node metastasis of pancreatic carcinoma

作　　者：田艳涛[1] 王成锋[1] 王贵齐[2] 赵心明[3] 欧阳汉[3] 郝玉芝[3] 陈雁[3] 张红梅[3] 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腔镜室,北京100021 [3]中国医学科学院肿瘤医院影像诊断科,北京100021

出　　处：《中华肿瘤杂志》2008年第9期682-685,共4页Chinese Journal of Oncology

基　　金：国家“十五”攻关课题资助项目（2004BA703B11）;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：目的评价超声（US）、螺旋CT（HCT）、核磁共振成像（MRI）和内镜超声（EUS）等4种影像学检查，对胰腺癌肿瘤局部血管浸润及淋巴结转移的预测价值。方法对68例胰腺癌患者术前分别进行US、HCT、MR／和EUS检查，记录其肿瘤局部血管浸润及淋巴结转移的手术病理结果，对影像学检查与手术病理结果的一致性和相关性进行分析。结果（1）US对于肿瘤侵犯下腔静脉、脾动脉、脾静脉的评估与手术病理结果中度一致，HCT对肿瘤侵犯肠系膜上静脉、门静脉、脾静脉的评估结果与手术病理结果高度一致，对肠系膜上动脉、下腔静脉、脾动脉、肝总动脉、肝固有动脉、腹腔动脉干、腹主动脉的评估结果与手术病理结果中度一致。MRI对肿瘤侵犯肠系膜上动脉、肠系膜上静脉、脾动脉、脾静脉的评估结果与手术病理结果中度一致。EUS对肿瘤侵犯脾静脉的评估结果与手术病理结果高度一致，对肿瘤侵犯肠系膜上静脉的评估结果与手术病理结果中度一致。（2）对淋巴结转移的评估，EUS具有最高的敏感性（75．0％）、准确性（87．5％）和阴性预测值（91．7％）。HCT和MRI的敏感性明显低于EUS，分别为37．5％和35．3％，US敏感性最低，仅为18．7％。多因素Logistic回归分析结果显示，EUS对淋巴结转移具有独立预测价值（OR=34．50，95％CI：6．54-182．09）。结论HCT评估胰腺癌肿瘤局部血管浸润与手术发现一致性最好，EUS对胰腺癌淋巴结转移具有独立预测价值。Objective To evaluate prospectively the efficacy of ultrasonography （US）, helical computed tomography （ HCT）, endoscopic ultrasonography （EUS） and magnetic resonance imaging （MRI） in the assessment of vascular invasion and lymph node metastasis in pancreatic carcinoma. Methods Consecutive 68 patients with pancreatic carcinoma were studied. Results of each imaging techniques regarding vascular invasion and lymph node metastasis were compared with the surgical and pathological findings. Results （1） US findings were confirmed moderately in accordance with surgical and pathological results in the evaluation of inferior cava vein, splenic artery and vein invasion of pancreatic carcinoma. HCT findings of evaluating superior mesenteric vein, portal vein, splenic vein were confirmed greatly in accordance with surgical and pathological results. The results of evaluating superior mesenteric artery, inferior cava vein, splenic artery, commom hepatic artery, proper hepatic artery, celiac trunk, abdomminal aorta were confirmed moderately in accordance with surgical and pathological results. MRI findings of evaluating superior mesenteric artery and vein, portal artery and vein were moderately in accordance with surgical and pathological results. EUS findings of evaluating splenic vein were confirmed greatly in accordance with surgical and pathological results, and moderately in accordance with surgical and pathological results in the evaluation of superiormesenteric vein. （ 2 ） EUS had the highest sensitivity （ 75. 0% ） , accuracy （ 87. 5% ） , and negative predictive values （91.7%） in the evaluation of lymph node metastasis. The sensitivity of HCT and MRI were 37.5% and 35.3% , which were significantly lower than that of EUS. The sensitivity of US was 18.7%, which was the lowest of all. In addition, the multivariate logistic regression analysis confirmed that EUS had an independent predictive value（OR： 34.50, 95% CI： 6.54-182.09）. Conclusion Helical CT should be considered the most p

关 键 词：胰腺肿瘤 超声检查 多普勒 彩色 腔内超声检查 螺旋CT 核磁共振 诊断 

分 类 号：R686[医药卫生—骨科学]