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【摘要】 目的 对三种MSCT扫描方案是否适合于术前评估进行比较研究,从而确定最佳增强扫描方案。方法 本课题研究对象为38例壶腹周围癌,均行三种不同时相螺旋CT检查。将结果分为三组进行对比分析,第1组(动脉期和门脉期),第2组(胰腺实质期和门脉期),第3组(动脉期、胰腺实质期和门脉期)。对壶腹周围癌于三种不同时相影像诊断与手术病理或ERCP活检结果进行比较,评估肿瘤是否可以手术切除,并与手术结果对照。结果 三组扫描方式对壶腹周围癌术前可切除性评价的阳性预测值、阴性预测值、特异度及准确率分别为:第1组:88.5%、66.7%、80%、81.6%,第2组:100%、80%、100%及94.7%,第3组:100%、88.9%、100%及97.4%。第1组诊断结果与第3组间有统计学差异。结论 多层螺旋CT三期扫描应作为壶腹周围癌术前评估的最佳扫描方案,联合应用低张法能显著提高壶腹周围癌的诊断符合率,并为术式选择提供重要依据。
【关键词】壶腹周围癌;多层螺旋CT(MSCT);外科手术
Three Scanning time of MSCT Examinations in the Preoperative Evaluation of Peri ampulla Carcinoma
WANG Yu,ZHU Wen yong,HAN Yan,et al.Department of zaozhuang municipal hospital,Zaozhuang 277102,China
【Abstract】 Objective On the three combined in terms of predictability for studied surgical resectability assessment of Periampulla Carcinoma.The final choice best enhanced scanning options.Methods 38 patients suspected of having Periampulla Carcinoma were divided into 3 groups,and MDCT scans were performed with different scanning techniques for these groups:group 1,with arterial phase and portal venous phase;group 2,with pancreatic parenchyma phase and portal venous phase;group 3,with arterial phase,pancreatic parenchyma phase and portal venous phase.For patients with Periampulla Carcinoma were included in the imaging analyses and and histopathologic results.The tumor resectability was also evaluated and eventually correlated with surgical results.Results The positive predictive value,negative predictive value,sensitivity,specificity and accuracy of these three groups were as follows respectively:88.5%、66.7%、80%、81.6% for group 1; 100%、80%、100%、94.7%for group 2;and 100%、88.9%、100%、97.4%for group 3.Conclusion Three phases scan should be as Periampullary Cancer surgery the best scanning program,combined with low tension can significantly improve Periampullary Ca diagnosis and to provide important basis for the selection of surgery.
【Key words】Periampulla Carcinoma;Multi slice Helical CT(MSCT);Surgery
MSCT问世以来,扫描速度得到很大的提高,使得胰腺三期增强扫描成为可能,从而壶腹周围癌的CT检出率越来越高。本研究共收集38例壶腹周围癌患者,均行三种时相增强螺旋CT检查,然后对三种增强方案进行比较,评估哪种方案更适合于壶腹周围癌的术前评估。
1 资料与方法
1.1 一般资料 本研究收集38例壶腹周围癌患者,均经手术病理或ERCP活检证实,男23例,女15例,年龄36~76岁,平均(52.5±4.1)岁。其中胰头癌16例,壶腹癌12例,十二指肠乳头癌4例,胆总管下端癌6例;其中共38例行低张下螺旋CT扫描,16例行MRCP检查,14例行ERCP检查。临床有黄疸、腹部不适、腹痛、或CA19 9值增高等表现,临床怀疑壶腹周围癌,后行螺旋CT、MRCP或ERCP检查,最后确诊经手术病理、ERCP检查或其他外科检查证实。
1.2 扫描方案 患者空腹,行低张下螺旋CT扫描,CT检查应用GE 16排多层螺旋CT扫描仪用高压注射器经肘前静脉团注碘海醇(300 mg I/ml),总量100 ml,流率4 ml/s,所有患者都进行三期增强扫描,延迟时间分别为动脉期20 s,胰腺期40S,门脉期60 s。扫描条件:120 kV,300 mA,层厚5.0 mm,螺距为1.375。增强前先进行CT平扫,扫描条件:120 kV,320 mA,螺距1.375,层厚5 mm。根据不同时相的组合,把图像分为三组。第一组:包括动脉期和门静脉期;第二组胰腺实质期和门静脉期;第三组包括动脉期、胰腺实质期和门静脉期。以最终结果为基准,对三种组合方案在是否适合手术预测方面进行对照研究。以最终选择最佳增强扫描方案。
2 结果
2.1 动脉期和门静脉期CT图像评估结果见表1。
表1
CT图像评估与确诊结果对照表(例)
类别可切除(术中等)不可切除(术中等)合计
可切除8(真阴性)4(假阴性)12
不可切除3(假阳性)23(真阳性)26
合计112738
注:假阴性未发现侵及SMV 3例,未发现侵及胃1例;假阳性误诊为SMV受侵3例
2.2 胰腺实质期和门静脉期CT图像评估结果见表2。
表2
CT图像评估与确诊结果对照(例)
类别可切除(术中等)不可切除(术中等结果)合计
可切除8(真阴性)2(假阴性)10
不可切除0(假阳性)28(真阳性)28
合计83038
注:假阴性未发现侵及SMV2例
2.3 三期CT扫描图像评估结果见表3。
【关键词】壶腹周围癌;多层螺旋CT(MSCT);外科手术
Three Scanning time of MSCT Examinations in the Preoperative Evaluation of Peri ampulla Carcinoma
WANG Yu,ZHU Wen yong,HAN Yan,et al.Department of zaozhuang municipal hospital,Zaozhuang 277102,China
【Abstract】 Objective On the three combined in terms of predictability for studied surgical resectability assessment of Periampulla Carcinoma.The final choice best enhanced scanning options.Methods 38 patients suspected of having Periampulla Carcinoma were divided into 3 groups,and MDCT scans were performed with different scanning techniques for these groups:group 1,with arterial phase and portal venous phase;group 2,with pancreatic parenchyma phase and portal venous phase;group 3,with arterial phase,pancreatic parenchyma phase and portal venous phase.For patients with Periampulla Carcinoma were included in the imaging analyses and and histopathologic results.The tumor resectability was also evaluated and eventually correlated with surgical results.Results The positive predictive value,negative predictive value,sensitivity,specificity and accuracy of these three groups were as follows respectively:88.5%、66.7%、80%、81.6% for group 1; 100%、80%、100%、94.7%for group 2;and 100%、88.9%、100%、97.4%for group 3.Conclusion Three phases scan should be as Periampullary Cancer surgery the best scanning program,combined with low tension can significantly improve Periampullary Ca diagnosis and to provide important basis for the selection of surgery.
【Key words】Periampulla Carcinoma;Multi slice Helical CT(MSCT);Surgery
MSCT问世以来,扫描速度得到很大的提高,使得胰腺三期增强扫描成为可能,从而壶腹周围癌的CT检出率越来越高。本研究共收集38例壶腹周围癌患者,均行三种时相增强螺旋CT检查,然后对三种增强方案进行比较,评估哪种方案更适合于壶腹周围癌的术前评估。
1 资料与方法
1.1 一般资料 本研究收集38例壶腹周围癌患者,均经手术病理或ERCP活检证实,男23例,女15例,年龄36~76岁,平均(52.5±4.1)岁。其中胰头癌16例,壶腹癌12例,十二指肠乳头癌4例,胆总管下端癌6例;其中共38例行低张下螺旋CT扫描,16例行MRCP检查,14例行ERCP检查。临床有黄疸、腹部不适、腹痛、或CA19 9值增高等表现,临床怀疑壶腹周围癌,后行螺旋CT、MRCP或ERCP检查,最后确诊经手术病理、ERCP检查或其他外科检查证实。
1.2 扫描方案 患者空腹,行低张下螺旋CT扫描,CT检查应用GE 16排多层螺旋CT扫描仪用高压注射器经肘前静脉团注碘海醇(300 mg I/ml),总量100 ml,流率4 ml/s,所有患者都进行三期增强扫描,延迟时间分别为动脉期20 s,胰腺期40S,门脉期60 s。扫描条件:120 kV,300 mA,层厚5.0 mm,螺距为1.375。增强前先进行CT平扫,扫描条件:120 kV,320 mA,螺距1.375,层厚5 mm。根据不同时相的组合,把图像分为三组。第一组:包括动脉期和门静脉期;第二组胰腺实质期和门静脉期;第三组包括动脉期、胰腺实质期和门静脉期。以最终结果为基准,对三种组合方案在是否适合手术预测方面进行对照研究。以最终选择最佳增强扫描方案。
2 结果
2.1 动脉期和门静脉期CT图像评估结果见表1。
表1
CT图像评估与确诊结果对照表(例)
类别可切除(术中等)不可切除(术中等)合计
可切除8(真阴性)4(假阴性)12
不可切除3(假阳性)23(真阳性)26
合计112738
注:假阴性未发现侵及SMV 3例,未发现侵及胃1例;假阳性误诊为SMV受侵3例
2.2 胰腺实质期和门静脉期CT图像评估结果见表2。
表2
CT图像评估与确诊结果对照(例)
类别可切除(术中等)不可切除(术中等结果)合计
可切除8(真阴性)2(假阴性)10
不可切除0(假阳性)28(真阳性)28
合计83038
注:假阴性未发现侵及SMV2例
2.3 三期CT扫描图像评估结果见表3。