Vargas Rafael, Nino-Murcia Matilde, Trueblood Ward, Jeffrey R Brooke
Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Room H1307, Stanford, CA 94305, USA.
AJR Am J Roentgenol. 2004 Feb;182(2):419-25. doi: 10.2214/ajr.182.2.1820419.
The objective of our study was to determine the negative predictive value of MDCT with curved planar reformations for detecting vascular invasion and predicting overall resectability in patients with pancreatic adenocarcinoma.
Imaging findings related to vascular invasion and overall tumor resectability in 25 patients who underwent contrast-enhanced biphasic MDCT evaluation were correlated with actual vessel invasion and overall resectability determined at surgery and pathologic examination. The presence of vascular invasion was assessed in 110 major peripancreatic vessels in 22 patients who underwent resection.
On MDCT, 23 (92%) of 25 patients were deemed to have resectable pancreatic adenocarcinoma. The tumors in the remaining two (8%) were considered not resectable because of the presence of vascular invasion (which was confirmed in only one patient at surgery). Of those 23 patients deemed to be candidates for curative resection on the basis of MDCT results, 20 were found to have resectable adenocarcinoma at time of surgery, yielding a negative predictive value for MDCT of 87% (20/23 patients) for overall resectability. In the other three patients, adenocarcinoma was deemed to be unresectable because of small metastases to the liver (two patients) or to the peritoneum (one patient) discovered at surgery. For detection of vascular invasion, MDCT yielded a negative predictive value of 100% (108/108 vessels) with no false-negative findings and an accuracy of 99% (109/110 vessels) with 108 true-negative findings, one true-positive finding, and one false-positive finding.
Our preliminary data on MDCT show that the technique has excellent negative predictive value for vascular invasion and good negative predictive value for overall tumor resectability in patients with pancreatic adenocarcinoma, suggesting an improvement over previous results reported using single-detector CT. The problem of undetected micrometastases to the liver and peritoneum remains.
我们研究的目的是确定多排螺旋CT（MDCT）曲面重组在检测胰腺腺癌患者血管侵犯及预测总体可切除性方面的阴性预测值。
对25例行双期增强MDCT评估的患者中与血管侵犯及肿瘤总体可切除性相关的影像表现，与手术及病理检查确定的实际血管侵犯和总体可切除性进行对比。对22例行手术切除患者的110条胰腺周围主要血管评估血管侵犯情况。
MDCT检查时，25例患者中有23例（92%）被认为胰腺腺癌可切除。其余2例（8%）因存在血管侵犯（仅1例在手术中得到证实）被认为不可切除。在根据MDCT结果被认为可进行根治性切除的23例患者中，20例在手术时被发现腺癌可切除，MDCT对总体可切除性的阴性预测值为87%（20/23例患者）。另外3例患者，因手术中发现肝脏（2例）或腹膜（1例）有小转移灶而被认为腺癌不可切除。对于血管侵犯的检测，MDCT的阴性预测值为100%（108/108条血管），无假阴性结果，准确率为99%（109/110条血管），有108条真阴性结果、1条真阳性结果和1条假阳性结果。
我们关于MDCT的初步数据表明，该技术在胰腺腺癌患者血管侵犯方面具有出色的阴性预测值，在肿瘤总体可切除性方面具有良好的阴性预测值，提示较之前使用单排螺旋CT报道的结果有所改善。肝脏和腹膜未被检测到的微转移问题仍然存在。
