Thompson Scott M, Vella Adrian, Service F John, Grant Clive S, Thompson Geoffrey B, Andrews James C
College of Medicine, Mayo Clinic, Rochester, MN.
College of Medicine, Mayo Clinic, Rochester, MN.
Surgery. 2015 Jul;158(1):162-72. doi: 10.1016/j.surg.2015.03.004. Epub 2015 Apr 11.
To determine the impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation (SACST) with hepatic venous sampling for preoperative localization of occult insulinoma.
An institutional review board-approved retrospective review was undertaken of 42 patients with surgically confirmed, occult insulinoma who underwent SACST from January 1996 to March 2014. Location of the insulinoma was predicted initially based on the biochemical results of SACST alone according to Doppman's criteria. Pancreatic arteriograms were reviewed blinded to the biochemical results and the regional perfusion of each artery assessed. The anatomic and perfusion data were combined with the biochemical results to make a second prediction and compared with the surgical findings.
The biochemical results were positive in 1, 2, and 3 arterial distributions in 73.8%, 21.4%, and 4.8% of patients, respectively. The celiac trunk and superior mesenteric artery (SMA) anatomy were aberrant in 38.1% and 35.7% of patients, respectively. Clinically significant variations included dorsal pancreatic artery replaced to SMA (21.4%) and celiac stenosis (4.8%). Significant variation and overlap in regional pancreatic perfusion was observed, particularly for the SMA. Sensitivity for insulinoma localization was 54.8% (diagnostic arteriography), 73.8% (biochemical data), 88.1% (biochemical, anatomic, perfusion data), and 92.8% (arteriographic, biochemical, anatomic, perfusion data).
Careful review of the pancreatic arterial anatomy and regional perfusion is critical for correct interpretation of the biochemical results of SACST and improves the sensitivity of localization for occult insulinoma, particularly in the presence of pancreatic arterial variants or overlap in regional perfusion.
确定胰腺动脉变异和区域灌注重叠对选择性动脉钙刺激试验（SACST）联合肝静脉采血术前定位隐匿性胰岛素瘤结果判读的影响。
对1996年1月至2014年3月期间42例经手术证实的隐匿性胰岛素瘤患者进行了一项经机构审查委员会批准的回顾性研究，这些患者均接受了SACST。最初根据Doppman标准仅依据SACST的生化结果预测胰岛素瘤的位置。在不知生化结果的情况下回顾胰腺动脉造影，并评估每条动脉的区域灌注情况。将解剖学和灌注数据与生化结果相结合进行第二次预测，并与手术结果进行比较。
分别有73.8%、21.4%和4.8%的患者在1、2和3个动脉分布区域的生化结果呈阳性。分别有38.1%和35.7%的患者腹腔干和肠系膜上动脉（SMA）解剖结构异常。具有临床意义的变异包括替代至SMA的胰背动脉（21.4%）和腹腔干狭窄（4.8%）。观察到胰腺区域灌注存在显著变异和重叠，尤其是SMA。胰岛素瘤定位的敏感性分别为54.8%（诊断性动脉造影）、73.8%（生化数据）、88.1%（生化、解剖、灌注数据）和92.8%（动脉造影、生化、解剖、灌注数据）。
仔细评估胰腺动脉解剖结构和区域灌注对于正确判读SACST的生化结果至关重要，可提高隐匿性胰岛素瘤定位的敏感性，尤其是在存在胰腺动脉变异或区域灌注重叠的情况下。
