Richter G M, Simon C, Hoffmann V, DeBernardinis M, Seelos R, Senninger N, Kauffmann G W
Abteilung für Radiodiagnostik, Radiologische Universitätsklinik, Heidelberg.
Radiologe. 1996 May;36(5):397-405. doi: 10.1007/s001170050088.
To evaluate a new technique for imaging the pancreas (spiral hydro-CT) based on a combination of pharmacological intestinal paralysis and water distension of the stomach and duodenum with specific reference to tumor detection rate, differentiation of malignant versus benign tumors, differential diagnosis and assessment of tumor resectability.
In an open prospective study, 151 patients with a suspected pancreatic neoplasm based on clinical, laboratory or other imaging data were examined between May 94 and October 95. Our newly developed Hydro-CT methodology included intravenous injection of 40 mg N-butylscopolaminium bromide (Buscopan) for intestinal paralysis, gastric and duodenal wall distension by oral administration of an average of 1.51 warm tap water, 30 degrees RAO patient positioning, an individualized contrast injection technique as determined beforehand by time-to-peak measurement in the portal vein and thin-slice spiral CT (3 mm increment, 6 mm table feed and 3 mm secondary reconstruction). A detailed evaluation form was used to assess (1) tumor detection rate, (2) differentiation of malignant versus benign disease, (3) differential diagnosis, and (4) accuracy of assessment of resectability by identification of infiltration into adjacent organs and vessel structures relevant for resectability such as splenic, superior mesenteric, portal vein and celiac trunk, superior mesenteric, splenic and hepatic arteries. As the gold standard for positive tumor detection surgery and microscopic diagnosis were used, and for negative tumor detection an event-free survival of 6 months.
Almost all examinations were well tolerated. In only 4% was on-site administration of a gastric tube required because of vomiting. In 2% of the patients a slight allergic reaction to the contrast medium was seen. The prevalence of a pancreatic neoplasm was 38%. In tumor detection Hydro-CT reached an overall accuracy of 97.4% with a sensitivity of 100% and a specificity of 95.9%. In the differentiation of benign versus malignant disease Hydro-CT reached an overall accuracy of 89.7% with a sensitivity of 92.5% and a specificity of 83.3%. The prevalence of a pancreatic carcinoma was 24%; 4% other malignant tumors were found (distal common bile duct carcinoma, cystadenocarcinoma). Fifty-eight patients underwent surgical exploration. In those assessment of resectability reached an overall accuracy of 95% with a sensitivity of 90.5% and specificity of 100%.
The new technique of Hydro-CT based on thin slice and spiral methodology, including pharmacological intestinal paralysis and water distension, results in a high tumor detection rate and increases sensitivity and specificity of tumor differential diagnosis and of assessment of resectability.
评估一种基于药理学肠麻痹以及胃和十二指肠水扩张相结合的胰腺成像新技术（螺旋水CT），特别关注肿瘤检出率、良恶性肿瘤的鉴别、鉴别诊断以及肿瘤可切除性的评估。
在一项开放性前瞻性研究中，于1994年5月至1995年10月期间对151例基于临床、实验室或其他影像学数据怀疑患有胰腺肿瘤的患者进行了检查。我们新开发的水CT方法包括静脉注射40毫克溴丁东莨菪碱（解痉灵）以实现肠麻痹，通过口服平均1.51升30摄氏度的温水使胃和十二指肠壁扩张，患者取右前斜30度体位，采用事先通过门静脉峰值时间测量确定的个体化造影剂注射技术以及薄层螺旋CT（层厚增量3毫米、床速6毫米和层厚3毫米的二次重建）。使用详细的评估表来评估：（1）肿瘤检出率；（2）良恶性疾病的鉴别；（3）鉴别诊断；（4）通过识别对可切除性至关重要的相邻器官和血管结构（如脾静脉、肠系膜上静脉、门静脉和腹腔干、肠系膜上动脉、脾动脉和肝动脉）的浸润情况来评估可切除性的准确性。将手术和显微镜诊断作为肿瘤阳性检测的金标准，对于肿瘤阴性检测则以6个月的无事件生存期作为标准。
几乎所有检查耐受性良好。仅4%的患者因呕吐需要现场插入胃管。2%的患者对造影剂有轻微过敏反应。胰腺肿瘤的患病率为38%。在肿瘤检测方面，水CT的总体准确率达到97.4%，敏感性为100%，特异性为95.9%。在良恶性疾病的鉴别方面，水CT的总体准确率达到89.7%，敏感性为92.5%，特异性为83.3%。胰腺癌的患病率为24%；发现4%为其他恶性肿瘤（远端胆总管癌、囊腺癌）。58例患者接受了手术探查。在这些患者中，可切除性评估的总体准确率达到95%，敏感性为90.5%，特异性为100%。
基于薄层和螺旋技术的水CT新技术，包括药理学肠麻痹和水扩张，可实现较高的肿瘤检出率，并提高肿瘤鉴别诊断和可切除性评估的敏感性和特异性。
