Angeli E, Venturini M, Vanzulli A, Sironi S, Castrucci M, Salvioni M, Zerbi A, Di Carlo V, Del Maschio A
Department of Radiology, Scientific Institute H. S. Raffaele, University Hospital, Milan, Italy.
AJR Am J Roentgenol. 1997 Jan;168(1):193-7. doi: 10.2214/ajr.168.1.8976945.
The aim of our study was to assess the accuracy of color Doppler imaging in diagnosing the involvement of peripancreatic vessels by pancreatic carcinoma.
We prospectively evaluated the color Doppler images of 61 patients with pancreatic carcinoma. Our evaluations occurred before surgery and focused on vascular involvement. Absence of contact or a short contiguity (< or = 2 cm) between tumors and peripancreatic vessels was considered to be a sign of resectability on color Doppler imaging; a long contiguity (> 2 cm), compression, encasement, or thrombosis was considered to be a sign of unresectability. In all patients, the sonographic diagnosis was compared with the surgical results.
With color Doppler imaging, we detected signs of vascular involvement in 26 of 33 patients in whom vascular involvement was found at surgery. We detected no vascular involvement in 25 of 28 patients in whom no vascular involvement was found at surgery. No false-positive diagnoses occurred when vascular encasement was revealed by color Doppler imaging. For diagnosis of vascular involvement, the sensitivity, specificity, and overall accuracy of color Doppler imaging were 79%, 89%, and 84%, respectively; positive and negative predictive values were 89% and 79%, respectively.
Color Doppler imaging is a sensitive and highly specific technique in assessing vascular involvement by pancreatic cancer when absence of contact or vascular encasement is seen. When vascular encasement is detected by color Doppler imaging, a definitive diagnosis of unresectability can be made, and further diagnostic procedures can be avoided. When sonography is used in the initial evaluation of pancreatic cancer, color Doppler imaging can improve the selection of patients for further diagnostic examinations or surgical exploration.
本研究旨在评估彩色多普勒成像在诊断胰腺癌累及胰周血管方面的准确性。
我们前瞻性地评估了61例胰腺癌患者的彩色多普勒图像。评估在手术前进行，重点关注血管受累情况。肿瘤与胰周血管无接触或短毗邻（≤2 cm）被认为是彩色多普勒成像上可切除的征象；长毗邻（>2 cm）、受压、包绕或血栓形成被认为是不可切除的征象。对所有患者，将超声诊断结果与手术结果进行比较。
通过彩色多普勒成像，我们在手术中发现血管受累的33例患者中的26例检测到了血管受累迹象。在手术中未发现血管受累的28例患者中的25例未检测到血管受累。当彩色多普勒成像显示血管包绕时，未出现假阳性诊断。对于血管受累的诊断，彩色多普勒成像的敏感性、特异性和总体准确性分别为79%、89%和84%；阳性和阴性预测值分别为89%和79%。
当观察到无接触或血管包绕时，彩色多普勒成像在评估胰腺癌血管受累方面是一种敏感且高度特异的技术。当彩色多普勒成像检测到血管包绕时，可做出不可切除的确切诊断，避免进一步的诊断程序。当超声用于胰腺癌的初始评估时，彩色多普勒成像可改善对患者进行进一步诊断检查或手术探查的选择。
