Jin Z, Li X, Cai L
Department of Radiology, Peking Union Medical College Hospital, Beijing 100730.
Chin Med Sci J. 2001 Mar;16(1):40-5.
To evaluate the respective value of dual-phase helical CT arterial portography (CTAP) and conventional angiography in preoperative predicting resectability of pancreatic ductal adenocarcinoma.
Tumor resectability was prospectively evaluated in 54 patients with pathologically proven pancreatic ductal adenocarcinoma who later underwent surgery. Both dual-phase helical CT scanning and selective angiography were obtained in each patient preoperatively. For optimal enhancement of pancreas and major peripancreatic vessels, two catheters connected to an automatic injector via a Y-shaped tube were placed selective angiography, one in celiac trunk, the other in superior mesenteric artery. Then the patient underwent dual-phase helical CTAP of pancreas and liver. The criteria of irresectability for CTAP include: tumor diameter > or = 5 cm, extrapancreatic invasion, distant metastases and vascular involvement (occlusion, stenosis or semicircular encasement of superior mesenteric artery, hepatic artery, splenic artery, celiac axis; portal vein, superior mesenteric vein or splenic vein). The results of both modalities were correlated with findings from surgery or pathology.
Thirty-eight of 54 patients had nonresectable disease. In prediction the irresectability, sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy were 94.7%, 100%, 100%, 88.9%, 96.3% respectively for helical CTAP and 63.2%, 93.89%, 96.0%, 51.7%, 72. 2% respectively for selective angiography. In assessing vascular involvements, dual-phase helical CTAP was also superior to selective angiography.
Dual-phase helical CTAP is superior to angiography in assessing resectability of pancreatic ductal adenocarcinoma. The combination of the two modalities may further improve overall creatic
评估双期螺旋CT动脉门静脉造影（CTAP）和传统血管造影在术前预测胰腺导管腺癌可切除性方面的各自价值。
对54例经病理证实为胰腺导管腺癌且随后接受手术的患者进行前瞻性肿瘤可切除性评估。每位患者术前均进行了双期螺旋CT扫描和选择性血管造影。为实现胰腺及胰腺周围主要血管的最佳强化，在选择性血管造影时，通过一个Y形管连接两个导管至自动注射器，一个置于腹腔干，另一个置于肠系膜上动脉。然后患者接受胰腺和肝脏的双期螺旋CTAP检查。CTAP不可切除的标准包括：肿瘤直径≥5cm、胰腺外侵犯、远处转移和血管受累（肠系膜上动脉、肝动脉、脾动脉、腹腔干闭塞、狭窄或半圆形包绕；门静脉、肠系膜上静脉或脾静脉）。两种检查方式的结果均与手术或病理结果进行对照。
54例患者中有38例患有不可切除疾病。在预测不可切除性方面，螺旋CTAP的敏感性、特异性、阳性预测值、阴性预测值和总体准确率分别为94.7%、100%、100%、88.9%、96.3%，而选择性血管造影的分别为63.2%、93.89%、96.0%、51.7%、72.2%。在评估血管受累方面，双期螺旋CTAP也优于选择性血管造影。
在评估胰腺导管腺癌的可切除性方面，双期螺旋CTAP优于血管造影。两种检查方式联合使用可能进一步提高总体……（原文此处“overall creatic”表述有误，推测可能是“overall accuracy”之类，暂按原文翻译）
