CT泪滴状肠系膜上静脉征评价胰头癌不可切除性的意义

目的 研究CT泪滴状肠系膜上静脉（SMV）征能否可靠判断胰头癌的不可切除性,方法 回顾性分析98例经手术病理证实的胰头癌,对照分析CT表现及手术病理,评价泪滴状SMV征反映胰头癌不可切除性的敏感性,准确性和特异性。结果 在增强CT上,泪滴状SMV征结合其他CT表现可明显提高胰头癌不可切除的敏感性（从61％到89％）和准确性（从70％到91％）,但对可切除的特异性无显著影响（从100％到96％）,结论 泪滴状SMV征是胰头癌不可切除性的可靠表现,对术前手术方案的制定有指导意义。     

螺旋CT血管造影评价胰腺癌可切除性的意义

目的探讨螺旋CT血管造影（SCTA）诊断胰腺癌胰周血管侵犯及评价可切除性的价值。方法10例疑有局部浸润的胰腺癌患者术前行横断面CT及螺旋CT血管造影检查。比较分析SCTA与横断面CT诊断肿瘤侵犯胰周血管情况以及评价肿瘤可切除性。结果SCTA诊断胰周血管侵犯的敏感度、阴性预测值（100％、100％）高于横断面CT（81．8％、92．6％）。两者差异有统计学意义（P〈0．05）。SCTA术前评价胰腺癌可切除性的阳性预测值高于横断面CT。结论SCTA可精确地诊断胰腺癌侵犯胰周血管的情况，术前可准确评价胰腺癌可切除性。     

胰腺癌胰周血管受侵的MSCT表现及可切除性评估

目的探讨胰腺癌胰周血管受侵的MSCT表现及与手术结果的比较。方法 80例胰腺癌患者(后经临床综合诊断或病理证实)行MSCT三期增强扫描及三维重组。根据重建图像结合横断位图像对胰周主要血管进行识别。胰周主要血管包括腹腔动脉(CA),肠系膜上动脉(SMA),脾动脉(SA);门静脉(PV),脾静脉(SV),肠系膜上静脉(SMV)。将胰腺癌与血管的关系分为0～4级。评价270条胰周主要血管的影像资料,并与手术结果对照,分别计算各分级敏感性、特异性、阳性预测值及阴性预测值和准确率。结果不同部位、不同大小的肿瘤侵犯的胰周血管及其程度各不相同,随着MSCT分级的增高,对于胰腺癌手术可切除性判断的敏感性逐渐降低,而特异性逐渐升高。对于手术可切除性判断的敏感性、特异性均较高的MSCT影像分级是2级。结论多层螺旋CT胰周血管成像提高了胰腺癌的早期诊断率及手术可切除性判断的准确率。     

多层螺旋CT评价侵犯胰周血管的胰腺癌的可切除性

目的探讨多层螺旋CT（MSCT）评价侵犯胰周血管的胰腺癌的可切除性。方法收集经手术病理证实的胰腺导管细胞癌66例,根据MSCT所示的胰腺癌肿块与胰周血管之间的关系（累及血管周长、血管变形和狭窄的程度、累及血管纵轴的长度）预设五组指标判断胰周血管侵犯时胰腺癌的可切除性,计算各组指标的敏感性、特异性、准确性、假阴性、假阳性、阳性预测值及阴性预测值,并比较各组之间的差异。结果本组中行胰头十二指肠切除术（Whipple）30例;胰体尾切除17例,内引流17例,剖腹探查2例。手术探查无血管侵犯34例,血管侵犯32例。与手术病理结果对比,第一组各项指标均为优,第二组、第三组及第五组的假阴性或假阳性较高,第四组的敏感性及准确性大大低于第一组：结论综合血管受侵的周长、血管变形或狭窄程度及血管纵轴受累的长度,MSCT可用于术前评价胰腺癌的可切除性．     

螺旋CT扫描结合CA19-9检测在胰腺癌术前分期中的探讨

目的探讨螺旋CT双期扫描结合CAl9-9对判断胰腺癌可切除性方面的价值。方法回顾性收集37例在我院行螺旋CT双期扫描并经手术病理证实的患者，全部患者均有术前血清CAl9-9检测结果。结果CT对胰腺癌不可切除的判断准确率高达100％，对可切除性判断准确率只有78．57％。胰腺癌病人中CAl9-9的阳性率为82．86％，CAl9-9与肿瘤大小有关；CAl9—9在可切除组与不可切除组间存在显著性差异。结论螺旋CT结合CAl9-9在判定胰腺癌不可切除性方面有一定价值，尚不能得出CAl9-9对协助CT判定胰腺癌可切除性方面有肯定意义的结论。     

螺旋CT双相扫描对胰腺癌可切除性的评价

目的前瞻性评价双相螺旋CT（HCT）术前预测胰腺癌可切除性的诊断价值。方法应朋对比剂增强HCT对57例疑似胰腺癌病例进行双相扫描，并对其中28例手术病理证实的胰腺癌病人的术前诊断和分期进行研究。结果28例胰腺癌经外科探查，17例进行根治性切除，7例进行姑息手术。可切除性的阳性预测值为70．8％。7例CT发现可切除的病例，因血管侵犯（5例）、淋巴结转移（2例），术中未能切除。HCT作为判定胰腺癌可切除性的总的精确率为75％（21／28）。结论双相HCT扫描技术是胰腺癌术前分期和可切除性判断的一项有用方法。     

螺旋CT诊断不可切除性胰腺癌的价值分析

目的提高对不可切除性胰腺癌的认识及诊断水平。方法回顾分析经手术、病理证实不能手术切除之胰腺癌22例的CT表现，仔细观察平扫及增强各期正常部分胰腺和胰腺癌的形态、密度的变化，对其增强特点、胰周血管、胰周脂肪、是否累及胰周器官及转移特点进行重点分析。结果胰腺癌不可切除的征象有以下几点：胰周血管爱侵、淋巴结转移、邻近器官受侵、胰周小静脉迂曲扩张．胰周脂肪间隙模糊消失。结论螺旋CT双期扫描对胰腺癌诊断及不可切除性评估具有十分重要的临床价值。     

螺旋CT三期扫描对胰腺癌可切除性的分析

目的探讨螺旋CT三期扫描对胰腺癌与胰周脏器、血管侵犯及评价可切除性的价值。方法回顾分析12例胰腺癌患者术前螺旋CT多期扫描的资料,分析病灶的部位、大小及与周围脏器、胰周血管的关系等,9例与手术结果对照,3例随访证实。结果胰腺癌在胰腺实质期与胰腺组织间密度差别大,病变显示清晰;螺旋CT三期增强及图像后处理对周围脏器侵犯的准确性为75％,胰周动脉受侵评价的准确度为77．78％。结论螺旋CT三期增强及图像后处理能显示胰腺癌与周围脏器、胰周血管的情况,术前对评价胰腺癌可切除性有指导意义。     

螺旋CT对不可切除的胰腺癌诊断价值的探讨

目的探讨不能手术切除的胰腺癌CT表现及诊断标准：方法同顾性分析17例经手术、病理证实不能手术切除之胰腺癌的主要CT表现，对其增强特点，胰周脂肪、血管，临近器官、转移特点及扫描方法进行重点分析。结果胰腺癌不可切除的征象有以下几点：胰周血管受侵，肝转移及腹膜转移，临近器官受侵，远处淋巴结转移以及胰周脂肪层模糊同时伴有其他不可切除征象。结论螺旋CT增强扫描可以准确评估肿瘤侵犯范围、程度、以及转移情况，对血管受侵的显示尤为清晰。因此螺旋CT检查对判断胰腺癌是否可以切除具有重要意义。     

螺旋CT在胰腺癌诊断中的价值

目的:探讨螺旋CT在胰腺肿瘤诊断中的应用价值。方法:回顾分析经手术病理证实的43例胰腺癌的CT表现特点。结果:CT表现为胰腺内低密度肿块35例,胰腺形态和轮廓改变30例,胰胆管扩张21例,胰周血管侵犯19例,胰周淋巴转移3例,肝转移2例,腹膜种植12例。正确预测肿瘤不可切除性93.33%,正确预测可切除性为76.92%。结论:螺旋CT对胰腺癌的诊断准确率高,同时对胰腺癌是否伴有周围血管侵犯和转移的准确性也较高,亦是评价胰腺癌术前能否手术的有效方法。     

Preoperative assessment of pancreatic malignancy using endoscopic ultrasound

Background: Endoscopic ultrasound (EUS) has been regarded as the most accurate modality for locoregional staging of pancreatic malignancy. However, several recent studies have questioned this. The current study assessed the accuracy of EUS in determining preoperative resectability of pancreatic neoplasia. Methods: A retrospective review was performed of patients with pancreatic malignancy who had preoperative EUS and underwent surgery. EUS-predicted resectability was compared with surgical resectability. Where available, accuracies of vascular and nodal staging were also assessed. Results: Forty-five patients were identified (mean age = 60 years, age range = 36–79 years). All patients underwent surgical exploration; vascular staging was available in 32 cases and 17 cases underwent surgical resection. The sensitivity, specificity, and accuracy of EUS in determining unresectability were 66%, 100%, and 78% respectively. Overall EUS stage concurred with surgical stage in 56%, greater than surgical stage in 4%, and less than surgical stage in 40%. Vascular staging on EUS had a sensitivity of 69% and a specificity of 100%. Accuracy of nodal staging was 71%. Conclusion: EUS had a high specificity for assessing unresectable pancreatic malignancy. This technique should be used to avoid unnecessary surgical exploration of incurable lesions. However, EUS had only a moderate sensitivity, and a proportion of patients staged preoperatively as having resectable disease will not be surgically resectable.     

多层螺旋CT血管成像评价胰腺癌侵犯胰周血管

目的 观察多层螺旋CT血管成像(MSCTA)评价胰腺癌胰周血管受侵的价值.方法 对49例胰腺癌患者行螺旋CT增强扫描,结合多平面重建、最大密度投影、最小密度投影、曲面重建、三维容积再现等后处理技术对胰周主要血管进行成像.结果 49例患者中胰头、胰颈部癌33例,钩突癌8例,胰体癌5例,胰尾癌2例,全胰腺癌1例.胰周主要血管受侵包括腹腔干3 例,肝总动脉7例,肠系膜上动脉6例,脾动脉8例,门静脉16例,肠系膜上静脉24例, 脾静脉11例, 下腔静脉2例.MSCTA判断血管受侵准确率为87.75%,敏感度为88.57%,特异度为85.71%,阳性预测值为93.94%,阴性预测值为75.00%.结论 MSCTA能直观准确地显示胰腺癌对胰周血管的侵犯,术前MSCT多期增强扫描判断胰腺癌的胰周血管是否受侵对手术具有指导意义.     

术前增强CT预测胰头癌侵犯肠系膜上静脉/门静脉

目的 评估术前增强CT预测胰头癌侵犯肠系膜上静脉(SMV)/门静脉(PV)及其程度的价值.方法 回顾性分析166例经病理证实的胰头(含钩突部)癌患者,评估术前门静脉期CT所示肿瘤直径、边界,肿瘤与静脉(SMV/PV)接触界面(TVI)(0/≤180°/>180°)、肿瘤与静脉(SMV/PV)接触长度(LIV),有无静脉...     

胰周小静脉的观察在胰腺癌分期中的价值

目的　探讨胰周小静脉在胰腺癌分期中的作用。方法　对正常组 3 0例及胰腺癌 44例行螺旋CT双期扫描 ,即胰腺期和肝脏期 (注射对比剂后 3 5s和 70s)扫描。统计正常组胰腺期及肝脏期胰周小静脉的显示率 ,观察胰腺癌病例胰周小静脉扩张情况及其他改变。结果　正常组胰周小静脉的显示率为 73 %～ 90 % ,胰腺期优于肝脏期 ;胰周小静脉扩张者占不可切除性肿瘤的 41% (13 /3 2 )。结论　胰周小静脉的显示率胰腺期优于肝脏期 ,胰周小静脉的扩张可作为胰腺癌不可切除的重要参考。     

Power Doppler endoscopic ultrasonography for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis.

OBJECTIVE: The accuracy of endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration for the differential diagnosis of pancreatic masses is variable in the literature, being as low as 75% in some studies. The aim of the study was to assess the accuracy of power Doppler EUS for the differential diagnosis between pancreatic cancer and pseudotumoral chronic pancreatitis. METHODS: We included 42 consecutive patients with pancreatic tumor masses (27 men and 15 women) examined by EUS between January 2002 and August 2004. Endoscopic ultrasonographic procedures included power Doppler EUS as well as EUS-guided fine-needle aspiration in all patients. Final diagnosis of pancreatic cancer was confirmed in 29 patients on the basis of a combination of information provided by imaging tests, follow-up of at least 6 months, and laparotomy in 18 patients for diagnostic or palliative reasons. RESULTS: Sensitivity and specificity of the absence of power Doppler signals inside the suggestive pancreatic mass were 93% and 77%, respectively, with accuracy of 88%. Moreover, the addition of the information provided by the presence of peripancreatic collaterals improved the sensitivity and specificity to 97% and 92%, with accuracy of 95%. CONCLUSIONS: Power Doppler EUS provides useful information for the differential diagnosis of pancreatic masses. The results were in concordance with previous studies that showed a hypovascular pattern of pancreatic carcinoma, as well as the formation of collaterals in advanced cases due to the invasion of the splenic or portal veins. Further studies of dynamic EUS with contrast agents are necessary to better characterize pancreatic masses.     

肿瘤与血管接触三级评价法在胰腺癌术前评价中的价值

目的 探讨多排螺旋CT(multidetector CT,MDCT)肿瘤与血管接触(tumor vessel contact,TVC)三级评价法在胰腺癌术前评价中的应用价值.方法 选取2017年1月至2019年3月在河南省南阳市中心医院行手术治疗的胰腺癌患者80例,术前给予MDCT检查,比较TVC三级评价法与手术探查结...