不同扫描方案的多层螺旋CT检查在胰腺癌术前评估中的价值  

Multiphasic Scanning Techniques of Contrast-enhanced MDCT Examinations in the Preoperative Evaluation of Pancreatic Carcinomas

作　　者：张红梅[1,2] 周纯武[1,2] 赵心明[1,2] 刘媛[1,2] 马霄红[1,2] 

机构地区：[1]中国协和医科大学,北京100021 [2]中国医学科学院肿瘤医院影像诊断科

出　　处：《放射学实践》2008年第10期1120-1124,共5页Radiologic Practice

摘　　要：目的:通过对3组病例行不同扫描时相的多层螺旋CT检查,分析不同扫描方案的胰腺多期增强扫描在胰腺癌术前评估中的价值。方法:将临床因怀疑胰腺癌而申请MDCT检查的病例随机分为3组,行不同扫描时相的MDCT增强扫描。三组病例的扫描时相分别为:第1组(动脉期和门脉期),第2组(胰腺实质期和门脉期),第3组(动脉期、胰腺实质期和门脉期)。图像分析内容包括肿瘤位置、有无周围器官及主要血管的侵犯、有无器官转移、腹膜或腹腔转移等,最后评估肿瘤是否可以手术切除,并与手术结果对照。计算每组病例的阳性预测值、阴性预测值、敏感性、特异性及准确率,并将诊断结果进行统计检验。结果:三组病例对于胰腺癌术前可切除性评价的阳性预测值、阴性预测值、敏感度、特异度及准确率分别为第1组:93.5%、66.7%、87.9%、80%及86%;第2组:100%、80%、93.8%、100%及95.0%;第3组:100%、87.5%、97.1%、100%及97.6%。第1组诊断结果与第3组间差异有显著性意义。结论:胰腺实质期与门脉期应作为胰腺癌术前MDCT增强的最基本扫描时相,如果需要进一步观察胰周动脉走行及肿瘤的供血情况,可以加做动脉期扫描。以原始横断面图像为基础,结合MPR、MIP、VR、CPR等重建技术,MDCT对于胰腺癌的术前可切除性评价多能做出正确诊断。Objective：To evaluate the effects of MDCT scans with different contrast-enhanced phases in preoperative surgical resectability assessment of pancreatic carcinoma. Methods：257 patients suspected of having pancreatic cancer were divided into 3 groups,and MDCT scans were performed with different scanning techniques for these groups： group 1, with arterial phase and portal venous phase; group 2, with pancreatic parenchyma phase and portal venous phase; group 3, with arterial phase, pancreatic parenchyma phase and portal venous phase. For patients with pancreatic carcinomas, their locations and sizes, peripancreatic organic involvement, peripancreatic vascular invasions, and metastases to the liver or peritoneum,if any,were included in the imaging analyses. The tumor resectability was also evaluated and eventually correlated with surgi- cal and histopathologic results. The positive predictive value, negative predictive value, sensitivity, specificity and accuracy were calculated in the end. Results：The positive predictive value, negative predictive value, sensitivity, specificity and accuracy of these three groups were as follows respectively：93.5%,66.7%,87.9%,80.0%,86.0% for group 1;100%,80.0%, 93.8%,100%,95.0% for group 2;and 100%,87.5%,97.1%,100%,97.6% for group 3. Conclusion：For patients suspected of having pancreatic cancer, the pancreatic parenchymal phase and the portal venous phase should be obtained as the has ie MDCT scan phases. The arterial phase could be added,in order to evaluate the peripancreatic vasculature and blood supply to the tumor. The original axial MDCT scans, together with the advanced postprocessing techniques such as MPR, MIP, VR and CPR,are of great help in preoperative tumor reseetability assessment of pancreatic cancer.

关 键 词：体层摄影术 X线计算机 胰腺肿瘤 危险性评估 

分 类 号：R735.9[医药卫生—肿瘤]