不同影像学方法对胰腺癌胰胆管梗阻程度的定量评估的比较  

Comparison of different imaging examinations for quantitative evaluation of the extent of pancreatieobiliary duct obstruction in pancreatic cancer

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

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院腹部外科,北京100021 [2]中国医学科学院中国协和医科大学肿瘤医院腔镜室,北京100021 [3]中国医学科学院中国协和医科大学肿瘤医院影像诊断科,北京100021

出　　处：《中华胰腺病杂志》2009年第5期306-308,共3页Chinese Journal of Pancreatology

基　　金：国家“十五”攻关课题资助项目（2004BA703811）;教育部高校博士点新教师基金资助项目（20070023114）;北京希望马拉松专项基金项目（LC2007A22）

摘　　要：目的前瞻性评估US、MSCT、EUS和MRI4种影像学方法在胰腺癌胰胆管梗阻程度定量评估中的价值。方法应用US、MSCT、EUS和MRI4种方法对连续收治的68例胰腺癌患者分别于术前测量其肝外胆管、胰管直径，评估其梗阻扩张程度，并与手术标本测量结果进行相关性分析。结果US、MSCT、MRI、EUS测量的肝外胆管直径分别为（16．60±6．33）mm、（18．90±6．74）mm、（18．80±5．88）mm和（17．26±4．83）mm，手术标本测量的直径为（18．39±6．05）mm。4种检查方法测量值与手术标本测量值的相关性分别为r=0．3839，P=0．1055；r=0．7113，P=0．0011；r=0．3759，P=0．0465；r=0．3376，P=0．2872。Kappa值分别为0．6285、0．7115、0．6661和0．7490。测量的胰管直径分别为（15．90±3．41）mm、（6．83±3．70）mm、（6．77±3．22）mm和（5．58±2．65）mm，手术标本测量的直径为（5．97±2．60）mm。4种检查方法测量值与手术标本测量值的相关性分别为r=0．3584，P=0．2895；r=0．6148，P〈0．0001；r=0．7373，P〈0．0001；r=1．0746，P〈0．0001。Kappa值分别为4．159、9．094、9．001和4．050，均具较好一致性。结论对肝外胆管、胰管梗阻的评估可首选us作为初筛，选择MRI或MSCT进行量化评估，必要时结合EUS，可较准确预测胆管、胰管梗阻程度。Objective To prospectively evaluate the value of US, MSCT, EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer. Methods Consecutive 68 patients with pancreatic carcinoma underwent US, MSCT, EUS and MRI before surgery. The diameter of extrahepatic bile duct and pancreatic duct were measured, and correlation analysis was performed with surgical specimens. Results Diameters of extrahepatic bile duct scaled by US, MSCT, EUS and MRI were （ 16.60± 6.33 ） mm, （ 18.90 ± 6.74） mm, （ 18.80 ± 5.88） mm and （ 17.26 ± 4.83 ） mm, and diameter measured from surgical specimens was （ 18. 39 ± 6. 05 ） mm; the correlation among the four imaging examinations and the surgical evaluation were r = 0. 3839, P = 0.1055 ; r = 0.7113, P = 0.0011 ; r = 0.3759, P=0. 0465; r = 0. 3376, P = 0. 2872, respectively. Kappa values were 0. 6285, 0. 7115, 0. 6661 and 0. 7490, respectively. The diameter of pancreatic duct was （ 15.90 ± 3.41 ） mm, （6. 83 ± 3.70 ） mm, （6.77 ± 3.22 ） mm and （ 5.58 ± 2.65 ） mm, and diameter measured from surgical specimens was （ 5.97 ± 2.60 ） ram, the correlation among the four imaging examinations and the surgical evaluation were r = 0. 3584, P = 0.2895; r = 0. 6148, P 〈0.0001 ; r =0.7373, P 〈0. 0001 ; r = 1. 0746, P 〈0.0001. Kappa values were 4. 159, 9. 094,9. 001 and 4. 050. All of these parameters were in coherence with surgical findings. Conclusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction. MRI and MSCT, combined with EUS if necessary, could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.

关 键 词：胰腺肿瘤 超声 内镜超声检查 多层螺旋CT 核磁共振 

分 类 号：R735.9[医药卫生—肿瘤]