Zhang Lei, Zhang Zhui-Yang, Ni Jian-Ming, Li Bin, Chen Fang-Ming, Jiang Chun-Juan, Hu Chun-Hong
From the *Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou; and †Department of Radiology, Wuxi Second People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, P.R. China.
J Comput Assist Tomogr. 2017 May/Jun;41(3):394-400. doi: 10.1097/RCT.0000000000000530.
The aim of this study was to evaluate the correlation between a 3-point scale multidetector computed tomography (MDCT) grading system and surgical exploration in predicting vascular invasion and resectability in patients with pancreatic ductal adenocarcinoma (PDA).
Fifty-five patients with surgical and pathologic confirmation of PDA were retrospectively analyzed by 3 radiologists independently. All patients had MDCT examination with multiplanar reformatted images, computed tomography (CT) angiography, and negative-contrast CT cholangiopancreatography (nCTCP). A 3-point scale CT grading system and criteria for unresectability adopting the latest guidelines were used in predicting the correlation between the invasion and resectability of 5 peripancreatic vessels and surgical grade and pathology.
Tumor location was correctly identified in all patients including 2 isodense lesions by means of nCTCP. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT were 92%, 83%, 95%, 78%, and 90%, respectively, in predicting tumor resectability compared with surgery and pathology and with good agreement (κ = 0.72-0.77). A correlation was observed between CT and surgical grade in predicting vascular invasion on a per-vessel basis, and the agreement presented as good to excellent (κ = 0.66-1.00).
A 3-point scale CT grading system is a simple and practical method in predicting peripancreatic vessel invasion and, importantly, correlates with surgical grade and pathology. Axial images combined with multiplanar reformation, nCTCP, and CT angiography can strengthen the comprehensive evaluation of PDA for resectability.
本研究旨在评估三点量表多排螺旋计算机断层扫描（MDCT）分级系统与手术探查在预测胰腺导管腺癌（PDA）患者血管侵犯及可切除性方面的相关性。
对55例经手术及病理证实为PDA的患者进行回顾性分析，由3名放射科医生独立完成。所有患者均接受了MDCT检查，包括多平面重组图像、计算机断层扫描（CT）血管造影及阴性对比剂CT胰胆管造影（nCTCP）。采用三点量表CT分级系统及依据最新指南制定的不可切除标准，预测5支胰腺周围血管的侵犯情况、手术分级及病理之间的相关性。
通过nCTCP在所有患者中均正确识别了肿瘤位置，包括2例等密度病变。与手术及病理结果相比，MDCT预测肿瘤可切除性的平均敏感度、特异度、阳性预测值、阴性预测值及准确率分别为92%、83%、95%、78%和90%，一致性良好（κ = 0.72 - 0.77）。在逐支血管预测血管侵犯方面，观察到CT与手术分级之间存在相关性，一致性为良好至优秀（κ = 0.66 - 1.00）。
三点量表CT分级系统是预测胰腺周围血管侵犯的一种简单实用的方法，重要的是，它与手术分级及病理相关。轴位图像联合多平面重组、nCTCP及CT血管造影可加强对PDA可切除性的综合评估。
