超声检查与螺旋CT在胰腺导管腺癌的识别与分期中的比较

Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma.

作者信息

Minniti Salvatore, Bruno Costanza, Biasiutti Carlo, Tonel Davide, Falzone Andrea, Falconi Massimo, Procacci Carlo

机构信息

Department of Radiology, University of Verona, Piazzale L. A. Scuro 1, 37134 Verona, Italy.

出版信息

J Clin Ultrasound. 2003 May;31(4):175-82. doi: 10.1002/jcu.10156.

DOI:10.1002/jcu.10156

PMID:12692824

Abstract

PURPOSE

The aim of this prospective study was to compare sonography with helical CT in the identification and staging of ductal adenocarcinoma of the pancreas.

METHODS

Sixty-four patients with histopathologically proven pancreatic ductal adenocarcinoma underwent both sonography and helical CT at our hospital between November 1, 2000, and October 31, 2001. These diagnostic imaging examinations were performed by 2 independent radiologists who were unaware of the findings of any other imaging or histopathologic examination and who assessed each case for the presence of tumor, involvement of peripancreatic vessels, the presence of metastases in the liver, and the resectability of the tumor. In the patients who underwent subsequent laparotomy, imaging-based diagnoses of overall resectability and vascular involvement were compared with surgical findings, which were considered the gold standard. Imaging-based diagnoses for the presence of hepatic metastases were compared with the findings of intraoperative sonography in patients who underwent radical resection and with the surgical findings in the patients who underwent palliative surgery; the operative findings were considered the gold standard.

RESULTS

In the identification of pancreatic adenocarcinoma, sonography was more accurate (61 of 64 tumors, 95.3%) than helical CT was (57 of 64 tumors, 89.1%). In the overall prediction of resectability among the 43 patients who underwent laparotomy, sonography (81.4%) was less accurate than CT was (86.0%). In diagnosing involvement of the superior mesenteric artery, sonography (95.3%) was more accurate than CT (88.4%). The 2 methods were equally accurate in diagnosing hepatic metastases (86.0%) and involvement of the celiac trunk (100%) and the superior mesenteric vein (88.4%), but sonography was less accurate than CT for diagnosing involvement of the common hepatic artery (90.7% versus 95.3%, respectively) and portal vein (88.4% versus 93.0%, respectively).

CONCLUSIONS

Sonography is more reliable than CT in identifying pancreatic adenocarcinoma, and its accuracy in staging is similar to that of CT.

摘要

目的

本前瞻性研究的目的是比较超声检查与螺旋CT在胰腺癌导管腺癌的识别和分期中的作用。

方法

2000年11月1日至2001年10月31日期间，64例经组织病理学证实为胰腺导管腺癌的患者在我院接受了超声检查和螺旋CT检查。这些诊断性影像学检查由2名独立的放射科医生进行，他们不知道任何其他影像学或组织病理学检查的结果，并对每个病例评估肿瘤的存在、胰周血管受累情况、肝脏转移的存在以及肿瘤的可切除性。在接受后续剖腹手术的患者中，将基于影像学的总体可切除性和血管受累诊断与手术结果进行比较，手术结果被视为金标准。将基于影像学的肝转移存在诊断与接受根治性切除患者的术中超声检查结果以及接受姑息性手术患者的手术结果进行比较；手术结果被视为金标准。

结果

在胰腺癌的识别中，超声检查（64个肿瘤中的61个，95.3%）比螺旋CT（6个肿瘤中的57个，89.1%）更准确。在43例接受剖腹手术的患者中，超声检查（81.4%）在总体可切除性预测方面不如CT（86.0%）准确。在诊断肠系膜上动脉受累方面，超声检查（95.3%）比CT（88.4%）更准确。两种方法在诊断肝转移（86.0%）、腹腔干受累（100%）和肠系膜上静脉受累（88.4%）方面同样准确，但在诊断肝总动脉受累（分别为90·7%和95·3%）和门静脉受累（分别为88.4%和93.0%）方面，超声检查不如CT准确。