CAJ | 학술논문

目的：探讨多排螺旋CT（MDCT）三期增强扫描诊断胰腺导管腺癌侵袭胰腺周围血管的价值。方法回顾性分析82例胰腺导管腺癌的MDCT三期增强及后处理图像资料和临床资料，分析胰腺癌胰周动脉和静脉入侵的MDCT征象，并与手术病理诊断结果相对照，获得MDCT判定不可切除肿瘤的阳性预测值。结果492例胰周大血管有157例受到肿瘤侵袭，其中动脉受侵64例，静脉受侵93例。有39%的受侵静脉(36/93)被肿瘤包绕大于1/2血管周长，而有97%(60/64)的受侵动脉被肿瘤包绕大于1/2血管周长甚至被肿瘤包埋(χ2=12.85，p<0.05)。有67%(62/93)的受侵静脉有血管狭窄或闭塞，而受侵动脉只有35%(26/64)(χ2=9.62，p<0.05)。有70%(65/93)的受侵静脉管壁呈不规则状，受侵动脉管壁不规则只有42%(13/64)(χ2=10.78，p<0.05)。MDCT判定可切除肿瘤为21例，不可切除肿瘤为61例，不可切除性的阳性预测值为98%。结论 MDCT三期动态增强扫描可较好的对胰腺导管腺癌侵袭胰腺周围大血管进行诊断，并能较准确的评估肿瘤是否可以切除。
목적：탐토다배라선CT（MDCT）삼기증강소묘진단이선도관선암침습이선주위혈관적개치。방법회고성분석82례이선도관선암적MDCT삼기증강급후처리도상자료화림상자료，분석이선암이주동맥화정맥입침적MDCT정상，병여수술병리진단결과상대조，획득MDCT판정불가절제종류적양성예측치。결과492례이주대혈관유157례수도종류침습，기중동맥수침64례，정맥수침93례。유39%적수침정맥(36/93)피종류포요대우1/2혈관주장，이유97%(60/64)적수침동맥피종류포요대우1/2혈관주장심지피종류포매(χ2=12.85，p<0.05)。유67%(62/93)적수침정맥유혈관협착혹폐새，이수침동맥지유35%(26/64)(χ2=9.62，p<0.05)。유70%(65/93)적수침정맥관벽정불규칙상，수침동맥관벽불규칙지유42%(13/64)(χ2=10.78，p<0.05)。MDCT판정가절제종류위21례，불가절제종류위61례，불가절제성적양성예측치위98%。결론 MDCT삼기동태증강소묘가교호적대이선도관선암침습이선주위대혈관진행진단，병능교준학적평고종류시부가이절제。
Objective To explore the diagnostic value of the three-phase multidetector CT(MDCT) in vascular involvement of pancreatic ductal adenocarcinoma. Methods The clinical data and CT studies of 82 patients with surgery and pathologically proved pancreatic ductal adenocarcinoma were analyzed retrospectively, and the vascular invasion based on CT signs were analyzed and compared to the results of surgery or pathology. The positive predictive values of unresectable tumors can be obtained. Results At MDCT exploration, 157 of 492 vessels were invaded by tumors, including 64 cases of arterial invasion and 93 cases of venous invasion. The invaded major peripancreatic arteries and veins presented different MDCT signs: 39% of the invaded veins(36/93) were surrounded by the tumor more than 50% of the vessel circumference, while 97%(60/64) of the invaded arteries, which were surrounded by tumors more than 50%of the vessel circumference or embedded in tumors (χ2=12.85, p<0.05). 67%(62/93) of the invaded veins and 35%(26/64) of the invaded arteries had vascular stenosis or obliteration (χ2=9.62, p<0.05). Irregularity of the vein wall(70%, 65/93) occurred more often than that of the artery wall(42%, 13/64)(χ2=10.78, p<0.05). 21 cases were resectable tumors, and 61 cases were unresectable tumors, and the positive predictive values of unresectable tumors is 98%. Conclusion Three-phase dynamic MDCT can be used to diagnose the vascular involvement of pancreatic ductal adenocarcinoma, and evaluate the unresectable tumors accurately.