CAJ | 학술논문

目的：探讨多层螺旋CT(MSCT)在原发性腹膜后肿瘤术前评估中的意义。方法26例经手术证实的原发性腹膜后肿瘤患者术前均行MSCT,并使用多平面重组(MPR)、容积再现(VR)、最大密度投影(MIP)等重建技术成像,对照分析影像结果与术中及病理结果。结果 MSCT通过多种后处理技术可清楚显示肿瘤与周围脏器和血管的解剖关系,CT所见26例中9例呈浸润性生长,包膜不完整；5例肾脏受压变形、移位；3例累及胰腺；3例侵犯十二指肠肠壁；2例累及输尿管；6邻近大血管受侵犯。26例均行手术切除,肿瘤均为单发,直径4cm-18cm。术中所见26例中,7例包膜不完整,9例侵犯邻近器官或组织,5例邻近血管受侵。与手术结果相比,术前MSCT对原发腹膜后肿瘤包膜评价的灵敏度和特异度分别为85%和84%；对肿瘤邻近器官侵犯评价的灵敏度和特异度分别为75%和69%；对邻近血管受侵评价的灵敏度和特异度分别为83%和90%。26例病理结果良性肿瘤及肿瘤样病变15例,恶性肿瘤11例,MSCT对肿瘤良恶性鉴别的准确率为74%。结论术中所见的肿瘤与周围脏器、血管的解剖关系与CT表现基本相符；病理所见与CT表现对应良好,MSCT有利于腹膜后肿瘤的术前可切除性评估及术中导向。
목적：탐토다층라선CT(MSCT)재원발성복막후종류술전평고중적의의。방법26례경수술증실적원발성복막후종류환자술전균행MSCT,병사용다평면중조(MPR)、용적재현(VR)、최대밀도투영(MIP)등중건기술성상,대조분석영상결과여술중급병리결과。결과 MSCT통과다충후처리기술가청초현시종류여주위장기화혈관적해부관계,CT소견26례중9례정침윤성생장,포막불완정；5례신장수압변형、이위；3례루급이선；3례침범십이지장장벽；2례루급수뇨관；6린근대혈관수침범。26례균행수술절제,종류균위단발,직경4cm-18cm。술중소견26례중,7례포막불완정,9례침범린근기관혹조직,5례린근혈관수침。여수술결과상비,술전MSCT대원발복막후종류포막평개적령민도화특이도분별위85%화84%；대종류린근기관침범평개적령민도화특이도분별위75%화69%；대린근혈관수침평개적령민도화특이도분별위83%화90%。26례병리결과량성종류급종류양병변15례,악성종류11례,MSCT대종류량악성감별적준학솔위74%。결론술중소견적종류여주위장기、혈관적해부관계여CT표현기본상부；병리소견여CT표현대응량호,MSCT유리우복막후종류적술전가절제성평고급술중도향。
Objective To explore the value of preoperative evaluation of multislice spiral CT (MSCT) in primary retroperitoneal tumor. Methods 26 cases of primary retroperitoneal tumor confirmed by surgery underwent preoperative MSCT and reconstruction techniques such as multiplanar reformat(MPR),Volume rendering(VR), Maximum intensity projection(MIP) etc were used. Imaging results were compared with the intraoperative and pathological results. Results Anatomic relationship of the tumor with adjacent organs and blood vessels could be clearly showed by a variety of MSCT post-processing techniques. Among all of 26 cases, invasive growth with incomplete capsules were seen in 9 cases, kidney compressed deformation and displacement of the kidney were seen in 5 cases; pancreas involved in 3 cases, duodenum intestinal wall involved in 3 cases, ureteral involved in 2 cases and large blood vessels involved in 6 cases. 26 patients were performed surgical resection. All of the tumor are single with the diameters were 4 cm~18 cm. During the operation, incomplete capsules were seen in 7 cases, adjacent organs or tissues involved in 9 cases, adjacent blood vessels involved in 5 cases. Compared with surgical results, sensitivity and speciality rate of preoperative MSCT evaluation for tumor’s capsules, involvement of adjacent organ, involvement of adjacent blood vessels were 85%and 84%, 75%and 69%, and 83%and 90%, respectively. There were 15 cases of benign tumors and 11 cases of tumor-like lesions. The benign and malignant differentiation accuracy of MSCT was 74%. Conclusion Intraoperative results of anatomic relationship between tumor and adjacent organs, blood vessels were consistent with MSCT. It is helpful for preoperative evaluation and intraoperative guidance for retroperitoneal tumors with MSCT.