多层螺旋CT三期增强扫描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] 周纯武[1] 赵心明[1] 刘媛[1] 马霄红[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021

出　　处：《癌症进展》2008年第5期504-509,共6页Oncology Progress

摘　　要：目的分析多层螺旋CT三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检查的病例行三期增强扫描,扫描时相及延迟时间分别为:动脉期20s、胰腺实质期45s、门脉期70s,并进行图像后处理;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。结果多层螺旋CT三期增强扫描对于胰腺癌术前可切除性评价的阳性预测值、阴性预测值、敏感性、特异性及准确性分别为100%、87.5%、97.1%、100%及97.6%。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;以原始横断位图像为基础,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 three-phase MDCT scanning in preoperative surgical resectability assessment of pancreatic carcinoma. Methods Totally 80 patients suspected of having pancreatic cancer were examined with three-phase MDCT, and the scanning technique were as follows： 20s for arterial phase, 45s for pancreatic parenchyma phase, and 70s for hepatic phase. For patients with pancreatic carcinomas, their locations and sizes, peripancreatic organic involvement, peripancreatic vascular invasions, and metastases to liver or to peritoneum pancreatic, if any, were included in the imaging analyses. The tumor resectability and its correlation with surgical and histopathologic results was also evalua- ted. Results The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of three-phase MDCT were 100%, 87.5%, 97. 1%, 100%, and 97.6%, respectively. Conclusions For patients suspected of having pancreatic cancer, the pancreatic parenchymal phase and the portal venous phase should be obtained as the basic MDCT scan phases. The arterial phase can be added 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 resectability assessment of pancreatic cancer.

关 键 词：多层螺旋CT 多期 可切除性 胰腺肿瘤 

分 类 号：R730.44[医药卫生—肿瘤] R735.9[医药卫生—临床医学]