Phoa S S, Reeders J W, Stoker J, Rauws E A, Gouma D J, Laméris J S
Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Br J Radiol. 2000 Nov;73(875):1159-64. doi: 10.1259/bjr.73.875.11144792.
The purpose of the study was to evaluate CT criteria for venous invasion in patients with potentially resectable carcinoma of the pancreatic head, with surgical and histopathological correlation. In 113 patients evaluated with spiral CT for suspected pancreatic head carcinoma, several CT criteria for venous invasion were scored prospectively for the portal vein (PV) and the superior mesenteric vein (SMV): length of tumour contact with PV/SMV (0 mm, < 5 mm, > 5 mm); circumferential involvement of the vein (0 degree, 0-90 degrees, 90-180 degrees, > 180 degrees); degree of stenosis; irregularity of the vessel margin; and tumour convexity towards vessel. 65 patients underwent surgery. Pancreatic head carcinoma was proven and pathology of the vascular margin was obtained in 50 of these patients. CT findings for single and combined criteria were correlated with pathology in these 50 patients, 30 of whom showed venous ingrowth. Invasion was found in all cases with SMV narrowing (n = 7), PV contour involvement > 90 degrees (n = 6), PV narrowing (n = 5) and PV wall irregularity (n = 3). The vascular ingrowth rate was 88% (15/17) for tumour concavity towards the PV or SMV. Poor predictors of ingrowth were length of tumour contact with PV > 5 mm (78% ingrowth, 14/18) and contour involvement of the SMV > 90 degrees (83% ingrowth, 10/12). Absence of vascular ingrowth could not be predicted in 100%. In conclusion, CT criteria can predict a high risk of invasion in potentially resectable tumours. Narrowing of the SMV and the PV seems the most reliable criterion, as well as circumferential involvement of the PV > 90 degrees. The best combination of criteria was tumour concavity with circumferential involvement > 90 degrees (sensitivity 60% and positive predictive value 90%).
本研究的目的是通过手术及组织病理学相关性评估，确定可切除的胰头癌患者静脉侵犯的CT标准。对113例疑似胰头癌患者进行螺旋CT检查，前瞻性地对门静脉（PV）和肠系膜上静脉（SMV）的几个静脉侵犯CT标准进行评分：肿瘤与PV/SMV接触的长度（0mm、<5mm、>5mm）；静脉的圆周受累情况（0度、0 - 90度、90 - 180度、>180度）；狭窄程度；血管边缘的不规则性；以及肿瘤向血管的凸度。65例患者接受了手术。其中50例患者确诊为胰头癌并获得了血管切缘的病理结果。在这50例患者中，将单一及联合标准的CT表现与病理结果进行了相关性分析，其中30例显示有静脉内生长。在所有SMV狭窄（n = 7）、PV轮廓受累>90度（n = 6）、PV狭窄（n = 5）和PV壁不规则（n = 3）的病例中均发现有侵犯。肿瘤向PV或SMV凹陷时，静脉内生长率为88%（15/17）。肿瘤与PV接触长度>5mm（内生长率78%，14/18）和SMV轮廓受累>90度（内生长率83%，10/12）是内生长的不良预测指标。无法100%预测无静脉内生长情况。总之，CT标准可预测可切除肿瘤的高侵袭风险。SMV和PV狭窄似乎是最可靠的标准，PV圆周受累>90度也是如此。最佳标准组合是肿瘤凹陷且圆周受累>90度（敏感性60%，阳性预测值90%）。
