Department of Surgery, Teikyo University, Tokyo, Japan.
HPB (Oxford). 2006;8(5):337-42. doi: 10.1080/13651820500540949.
The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.
随着诊断技术的进步，如对比增强多普勒超声（US）、螺旋 CT（CT）、增强磁共振成像（MRI）和内镜超声（EUS），诊断胰腺癌的能力迅速提高。每种技术都有其优点和局限性，因此根据目的和特点选择合适的诊断技术尤为重要。腹部 US 通常是首先用于识别腹痛或黄疸原因的方法，而常规 US 诊断胰腺肿瘤的准确性仅为 50-70%。CT 是用于检测和分期胰腺癌最广泛使用的成像检查。胰腺腺癌通常在对比增强 CT 上显示为低衰减区域。报道的螺旋 CT 显示胰腺癌的敏感性很高，范围在 89%至 97%之间。多排（MD）CT 可能改善胰腺癌的早期检测和准确分期。应该考虑到一些胰腺腺癌被描绘为等衰减，并且伴有胰腺癌的胰腺炎偶尔可能导致分期高估。据报道，T1 加权自旋回波图像加脂肪抑制和动态梯度回波 MRI 增强钆优于螺旋 CT 检测小病变。然而，慢性胰腺炎和胰腺癌不能根据动态增强 MRI 上的增强程度和时间来区分。EUS 在检测小肿瘤方面优于螺旋 CT 和 MRI，并且可以高度敏感地定位淋巴结转移或血管肿瘤浸润。EUS 引导下的细针抽吸活检是一种安全且高度准确的方法，可用于疑似胰腺癌患者的组织诊断。（18）F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）已被认为是一种有前途的无创方法，可用于区分良性和恶性病变。先前的研究报告 FDG-PET 检测恶性胰腺肿瘤的敏感性和特异性分别为 71-100%和 64-90%。FDG-PET 不能替代形态学成像，而是与之互补，因此在可疑病例中，该方法必须与其他成像方式相结合。
