腹腔神经节显示及胰腺癌侵犯的CT诊断  

Value of multi-slice spiral CT in the diagnosis of celiac ganglion invasion by pancreatic cancer

作　　者：邢培华 邵国良[2] 张燕如[3] 

机构地区：[1]桐庐县第一人民医院放射科,浙江杭州311500 [2]浙江杭州浙江省肿瘤医院放射介入科,310022 [3]桐庐县第一人民医院B超室,浙江杭州311500

出　　处：《影像诊断与介入放射学》2016年第4期306-310,共5页Diagnostic Imaging & Interventional Radiology

摘　　要：目的研究多层螺旋CT在胰腺癌腹腔神经节侵犯的诊断价值。方法回顾性分析71例胰腺癌患者多层螺旋CT表现,并与60例正常对照组进行比较,观察正常腹腔神经节形态、周围毗邻关系、CT值,以及受侵犯时的CT征象、CT值。结果正常对照组中,右侧腹腔神经节中呈细线状为55例(91.7%),呈长条、盘状为5例(8.3%),腹腔神经节三期CT均值分别为25.9±4.2、50.4±9.3和68.3±11.2 HU;左侧腹腔神经节呈细线状为16例(26.7%),长条、盘状为44例(73.3%),左侧腹腔神经节三期CT均值分别为27.3±4.4、49.8±8.1和72.9±11.7 HU,同侧肾上腺三期CT均值分别为31.2±6.8、77.9±18.7和79.2±12.2 HU,三期扫描腹腔神经节密度均低于同侧肾上腺,以动脉期腹腔神经节与同侧肾上腺密度差异最大(P<0.05)。胰腺癌患者组中右侧腹腔神经节三期CT均值分别为20.4±5.5、42.6±12.1和58.5±14.3 HU,左侧腹腔神经节三期CT均值分别为23.0±5.7、47.5±11.9和65.9±13.4 HU,胰腺癌患者组腹腔神经节CT值,三期均略低于对照组腹腔神经节CT值。胰腺癌患者组内18例螺旋CT图像显示腹腔神经节侵犯,其三期CT均值为21.1±4.7、40.9±8.4和57.9±12.4 HU,对比正常对照组左侧腹腔神经节三期CT值,其CT值明显降低(P<0.05)。根据胰腺癌患者组内疼痛的情况,分为顽固性疼痛组(20例)和无顽固性疼痛组(51例);在20例顽固性疼痛组患者中CT显示腹腔神经节周围间隙模糊或伴软组织影15例(75.0%),腹腔神经节周围间隙清晰6例(25.0%);在51例无顽固性疼痛患者中CT显示腹腔神经节周围间隙模糊或伴软组织影3例(5.9%),腹腔神经节周围间隙清晰48例(94.1%)(P<0.05)。结论多层螺旋CT对正常腹腔神经节的位置、形态及周围毗邻结构有良好的显示及分辨能力,并对胰腺癌腹腔神经节侵犯有较高的诊断价值。Objective To assess the value of multislice CT in demonstrating celiac ganglion invasion by pancreatic cancer. Methods Multi-slice spiral CT of 71 patients with pancreatic cancer and 60 healthy subjects was reviewed. The shape and CT density of the celiac ganglia and surrounding anatomy were analyzed. Results In normal subjects, the right and left celiac ganglia were thread-like （91.7%, 26.7%）, stripe or disc （8.3%, 73.3%） in shape with significantly （P〈0.05） lower CT densities in the unenhanced （25.9±4.2 HU, 27.3 ± 4.4 HU）, arterial （50.4±9.3 HU, 49.8±8.1 HU）, and venous （68.3±11.2 HU, 72.9±11.7 HU） phases than that of ipsilateral adrenal glands （31.2±6.8 HU, 77.9± 18.7 HU, 79.2±12.2 HU）. In pancreatic cancer, the CT densities of both the right and left celiac ganglia in the unenhanced （20.4±5.5 HU, 23.0±5.7 HU）, arterial （42.6±12.1 HU, 47.5±11.9 HU）, and venous （58.5± 14.3 HU, 65.9±13.4 HU） phases were lower than that of normal subjects. In 18 patients with pancreatic cancer invading the celiac ganglia, the 3-phase CT densities （21.1±4.7 HU, 40.9± 8.4 HU, 57.9 ± 12.4 HU） were significantly （P〈0.05） lower than that of left celiac ganglia in normal subjects. CT showed hazy soft tissue density around the celiac ganglia in 15/20 （75.0%） or normal surrounding density in 5/20 （25.0%） patients with intractable pain. Of 51 patients without intractable pain, CT showed hazy soft tissue density around the celiac ganglia in 3 （5.9%） or normal surrounding density in 48 （94.1% ）. Conelutsion Muhislice spiral CT clearly depicts the location, size, morphology, and pancreatic cancer invasion of the celiac ganglia.

关 键 词：腹腔神经节 胰腺癌 体层摄影术 X线计算机 

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