MSCT三级评价法对胰腺癌周围血管侵犯及肿瘤可切除性的术前评估价值  

The Preoperative Evaluation Value of MSCT for Peripancreatic Vascular Invasion and Pancreatic Cancer Resectability

作　　者：潘龙 马丽苹 徐华南 殷亚科 PAN Long;MA Liping;XU Huanan(The Third Peoples Hospital of Xinyang City,Xinyang,Henan Province 464000,P.R.China)

机构地区：[1]信阳市第三人民医院,464000 [2]郑州大学第一附属医院,450052

出　　处：《临床放射学杂志》2021年第10期1953-1957,共5页Journal of Clinical Radiology

摘　　要：目的探讨多层螺旋CT(MSCT)三级评价法对胰腺癌周围血管侵犯和肿瘤可切除性术前评估的应用价值。方法回顾性分析120例经手术及病理证实胰腺癌患者的临床和CT影像资料。采用胰腺癌病灶与周围血管接触三级评价法对胰周5支主要血管的侵犯情况进行评估。采用Spearman相关系数和Kappa分析比较CT和术中对胰周各支血管侵犯分级评估结果的相关性和一致性。根据其胰周血管侵犯情况及美国国家综合癌症网络(NCCN)诊疗指南及专家共识制定的胰腺癌可切除标准,将所有病例分为可切除组、交界可切除组和不可切除组;以手术和病理结果为参照,评估CT术前对胰腺癌肿瘤可切除性的诊断效能。结果120例手术证实胰腺癌患者包括可切除102例,不可切除18例。共评估胰周血管581支,CT分级与手术分级结果一致性Kappa值为0.829,相关系数r为0.894;其中交界可切除组CT分级与手术分级结果一致性Kappa值为0.915,相关系数r为0.963,不可切除组CT分级与手术分级结果一致性Kappa值为0.622,相关系数r为0.858;两组静脉CT与手术分级一致性和相关性均高于动脉。术前CT评估为可切除组81例,交界切除组25例,不可切除组14例;CT术前对可切除组胰腺癌评估的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和准确率分别为78.4%、94.4%、98.7%、43.6%和80.8%;对于胰腺癌可切除性(包括可切除组和交界可切除组)评估的敏感度、特异度、PPV、NPV和准确率分别为98.0%、66.7%、95.2%、85.7%和93.3%。结论CT三级评价法对胰周血管侵犯分级与手术结果具有较高的一致性,CT对术前评估胰腺癌可切除性具有较高的诊断效能。Objective To evaluate the diagnostic performance of 3-point CT grading system in the assessment of peripancreatic vascular invasion and pancreatic cancer resectability.Methods The clinical data and CT imaging data of 120 patients with surgical and pathologic confirmation of pancreatic cancer were retrospectively analyzed.The invasion of 5 main peripancreatic vessels were assessed by using a 3-point CT grading system according to tumor-to-vessel contact.The correlation and consistency of the results in the evaluation of the classification of vascular invasion between CT and surgery were analyzed by Spearman correlation coefficient and Kappa test.According to the clinical practice guidelines of National Comprehensive Cancer Network(NCCN)and expert consensus,the pancreatic cancer were divided into resectable,borderline resectable and unresectable.With the results of operation and pathology as standard,the CT diagnosis efficiency for pancreatic cancer resectability were assessed.Results In 120 patients who underwent surgery,the number of resectable group and unresectable group pancreatic cancer were 102 and 18,respectively.Total of 581 vessels were assessed.The correlation coefficient and Kappa value between CT and surgery in all group,borderline resectable group and unresectable group were0.829 and 0.894,0.915 and 0.963,0.622 and 0.858,respectively.Based on CT results,the number of resectable group,borderline resectable group and unresectable group were 82,28,and 10,respectively.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of CT were 96.3%,89.7%,95.1%92.1%,and94.1%,respectively,for resectable group;98.1%,57.1%,94.5%,80%,and 93.3%,respectively,for resectable and borderline resectable group.Conclusion The 3-point CT grading system in predicting peripancreatic vessel invasion had high consistency with surgery,and CT had high diagnostic efficacy in predicting preoperative pancreatic cancer resectability.

关 键 词：体层摄影术 X线计算机 胰腺癌 胰周血管 可切除性 

分 类 号：R735.9[医药卫生—肿瘤]