Sata N, Kurihara K, Koizumi M, Tsukahara M, Yoshizawa K, Nagai H
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji Minami-kawachi, Tochigi 329-0498, Japan.
Abdom Imaging. 2006 May-Jun;31(3):326-31. doi: 10.1007/s00261-005-0359-8. Epub 2005 Dec 5.
We sought to validate computed tomographic virtual pancreatoscopy (CT-VP) created by multidetector row CT (MD-CT) in the clinical diagnosis of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.
Five cases of pancreatic IPMNs were included in this study. A nasopancreatic drainage tube was inserted and the pancreatic duct was filled with contrast medium, after which an upper abdominal scan was performed by MD-CT. CT-VP and three-dimensional (3D) CT pancreatographic images were created using a workstation and compared with images by conventional diagnostic techniques. All cases were evaluated by endoscopic retrograde pancreatography (ERP) and three cases of main duct type were assessed by intraoperative real pancreatoscopy (RP).
In the main duct cases, papillary projections in the main pancreatic duct and branch orifices were clearly detected by CT-VP. These lesions and structures were confirmed by intraoperative RP, and the CT-VP images were clearer than RP images. In branch cases, a surface-rendering method allowed protruding lesions to be clearly detected in the dilated branches.
Compared with conventional ERP or RP, CT-VP and 3D-CT pancreatographic images were finer in quality, and the procedures were less invasive, faster, and less expensive. The potential shown by CT-VP with 3D-CT pancreatography in the clinical diagnosis of pancreatic IPMNs suggests that this approach may replace ERP in the near future.
我们试图验证由多排探测器计算机断层扫描（MD-CT）创建的计算机断层扫描虚拟胰管镜检查（CT-VP）在胰腺导管内乳头状黏液性肿瘤（IPMN）临床诊断中的应用。
本研究纳入5例胰腺IPMN患者。插入鼻胰引流管，向胰管内注入造影剂，然后用MD-CT进行上腹部扫描。使用工作站创建CT-VP和三维（3D）CT胰管造影图像，并与传统诊断技术的图像进行比较。所有病例均通过内镜逆行胰管造影（ERP）进行评估，3例主胰管型病例通过术中实体胰管镜检查（RP）进行评估。
在主胰管病例中，CT-VP能清晰检测到主胰管及分支开口处的乳头状突起。这些病变和结构在术中RP中得到证实，且CT-VP图像比RP图像更清晰。在分支型病例中，表面渲染法能清晰检测到扩张分支内的突出病变。
与传统的ERP或RP相比，CT-VP和3D-CT胰管造影图像质量更高，操作侵入性更小、速度更快且成本更低。CT-VP联合3D-CT胰管造影在胰腺IPMN临床诊断中显示出的潜力表明，这种方法可能在不久的将来取代ERP。
