胰周血管受胰腺癌侵犯程度常被影像学低估的原因分析  

The reasons of underestimating the extent of pancreatic cancer invasion of peripancreatic vessels through imaging

作　　者：李明山 孟凡琴 

机构地区：[1]北京市第一中西医结合医院放射科,北京100026 [2]清华大学第一附属医院病理科

出　　处：《实用放射学杂志》2016年第1期45-47,55,共4页Journal of Practical Radiology

摘　　要：目的 探讨胰周血管受侵程度被影像学低估的原因。方法 收集经手术病理证实或临床治疗证实的胰腺癌无远处转移患者76例，均行术前螺旋CT增强扫描，其中66例行MRI增强扫描并行三维血管重建，显示胰腺癌对周围血管的侵犯程度，把肿瘤对血管的侵犯程度分为0级、1级、2级、3级、4级。对术前评价可切除病例中的受侵犯的血管进行术中探查，并与手术结果对照。结果 39例中的138支血管受肿瘤侵犯达2级或以上，放弃手术，另37例术前评估有手术切除可能性,术中25例做了胰腺根治性切除，12例由于术前低估了1支或多支血管的受侵程度，仅做了肿块切除或姑息性治疗。此12例中有16支动脉血管及21支静脉血管受侵程度被低估,术中综合评估3级、4级的血管手术均无法切除，术中综合评估0级、1级的血管手术均顺利切除，评估为2级的血管受术者水平的影响而有部分切除。结论 术前用多层螺旋CT及MRI多期增强扫描并进行三维血管重建，评估动、静脉时使用不同的时像、不同的判定标准，可准确反映胰周血管受侵程度的准确信息。Objective To discuss the causes of underestimating the extent of pancreatic cancer invasion of peripancreatic vessels through imaging. Methods A total of 76 cases of patients with distant metastasis free pancreatic cancer confirmed by operative pa-thology or clinical treatment were collected and accepted enhanced spiral CT scanning before operation. Among of them, 66 cases of patients accepted enhanced MRI scanning and three dimensional vascular reconstruction. According to the images, the extents of pancreatic cancer invasion of peripancreatic vessels were divided into grade 0, grade 1, grade 2, grade 3, and grade 4. The numbers of vessels in each grade were counted and compared to the results of operation. Results There were 138 vessels in 39 cases with inva- sion extent higher than grade 2, so that the operations were given up. A total of 37 cases were assessed with the possibility of opera rive excision before operation. Among of them, 25 cases accepted radical excision of pancreas, however, 12 cases accepted tumor re section or palliative therapy alone because of preoperative underestimate of the invasion extent of one or more vessels. In these 12 ca- ses, the invasion extents of 16 arteries and 21 veins were underestimated. Operative excision could not be executed if the invasion ex tent was assessed as grade 3 and 4 during operation, while it could be executed if the invasion extent was assessed as grade 0 and 1 during operation. Moreover, operative excision depended on the condition of patients if the invasion extent was assessed as grade 2. Conclusion Diagnostic accuracy of the invasion extent of peripancreatic vessels could be improved by measures including preoperative muti-slice spiral CT scanning, enhanced mutiphasic MRI scanning and three-dimensional vascular reconstruction, as well as assess ment of arteries and veins in different time phases and with distinct criterions.

关 键 词：计算机体层成像 胰腺癌 切除率 界点 

分 类 号：R814.42[医药卫生—影像医学与核医学] R735.9[医药卫生—放射医学]