64层螺旋CT血管造影对胰腺恶性肿瘤血管受侵与可切除性的评估价值  

Preoperative evaluation of vascular involvement and general resectability of pancreatic carcinoma by using 64-slice spiral computed tomographical angiography

作　　者：张蕴[1] 荐志洁[1] 赵婷婷[1] 范妤欣[1] 麻少辉[1] 王林[2] 于良[2] 刘昌[2] 

机构地区：[1]西安交通大学医学院第一附属医院医学影像科,西安710061 [2]西安交通大学医学院第一附属医院医学肝胆外科,西安710061

出　　处：《中华医学杂志》2013年第19期1450-1453,共4页National Medical Journal of China

摘　　要：目的探讨术前64层螺旋cT血管造影（64-SCTA）在胰腺恶性肿瘤血管受侵程度与可切除性评估中的临床应用价值。方法回顾性分析西安交通大学医学院第一附属医院2009年10月至2012年3月34例胰腺恶性肿瘤的术前64-SCTA资料，将胰腺恶性肿瘤对邻近血管的侵犯程度分5级，分别对动脉、静脉的受侵程度与病变的可切除性进行评估，并与详细的手术记录进行了对照。结果病变邻近动脉受侵程度1级8例，2级6例，3级8例，4级10例，5级2例，评价经典切除术可切除的敏感性为92．9％，特异性为95．0％，准确性为94．1％，阳性预测值为92．9％，阴性预测值为95．0％，Kappa值0．879（P〈0．01），ROC曲线下面积为0．943（P〈0．01）。静脉受侵程度1级0例，2级6例，3级6例，4级13例，5级9例，评价经典切除术可切除的敏感性为78．6％，特异性为95．O％，准确性为88．2％，阳性预测值为91．7％，阴性预测值为86．4％，Kappa值0．752（P〈0．01），ROC曲线下面积为0．927（P〈0．01）。结论64-SCTA是术前评价胰腺恶性肿瘤邻近血管受侵程度、可切除性的方便、有效方法，准确性高，有很高的临床诊断和应用价值。Objective To assess for preoperative evaluation of 64-slice spiral computed tomographical angiography （64-SCTA） to predict vascular involvement and general resectability of pancreatic malignant tumors. Methods The material of 64-SCTA in 34 cases were retrospectively analyzed. Preoperative imaging findings were correlated with intraoperative and histopathologic results. Results For the arterial tumor invasion based on 64-SCTA findings, 1 grade was in 8 cases; 2 grade, 6 cases; 3 grade, 8 cases; 4 grade, 10 cases; 5 grade, 2 cases. Regarding respectability, the sensitivity, specificity, accuracy, positive predictive value （PPV）, negative predictive value （NPV） were 92. 9%, 95.0%, 94. 1% , 92. 9% , 95.0%. Kappa value was 0. 879 （ P 〈 0. 01 ）. Receiver operator characteristic （ROC） analysis revealed an area under the curve （ AUC ） of 0. 943 （ P 〈 0. 01 ）. For the venous tumor infiltration, lgrade was in 0 case; 2 grade, 6cases; 3 grade, 6 cases; 4 grade, 13 cases; 5 grade, 9 cases. Regarding respectability, these values for those tumors with vein invasion were 78.6% , 95.0% , 88.2% , 91.7% , 86.4%. Kappa value was 0.752 （P 〈 0.01）. ROC analysis showed an AUC of 0.927 （P〈0.01）. Conclusion 64-SCTA can provide reliable information for vascular involvement and general resectability of pancreatic malignant tumors. 64-SCTA has high value in clinical application.

关 键 词：胰腺肿瘤 体层摄影术 X线计算机 血管造影术 

分 类 号：R735[医药卫生—肿瘤] R730[医药卫生—临床医学]