多层螺旋CT扫描技术在胰腺癌诊断中的应用价值_临床医学论文.docVIP

多层螺旋CT扫描技术在胰腺癌诊断中的应用价值_临床医学论文 多层螺旋CT扫描技术在胰腺癌诊断中的应用价值_临床医学论文 【摘要】 目的 研究螺旋CT多期扫描技术在胰腺癌诊断中的临床应用价值。方法 88例胰腺癌患者行螺旋CT多期扫描，扫描时间为注射造影剂后18～25 s、40～45 s和60 s左右，比较正常胰腺组织和肿瘤在平扫和动脉期、胰腺期、门静脉期的增强变化。依照 CT征象诊断胰腺癌并行术前评估，并与手术结果比较。结果 正常胰腺组织在胰腺期的增强值明显高于其他两期 (F=12.22,0.01);胰腺-病灶增强差值胰腺期高于其他两期 (F=14.91,0.01)，肿块在胰腺期能够清晰显示。胰周血管在胰腺期显示满意，诸动脉在动脉期、胰腺期与门静脉期相比，差异有显著性(0.01);诸静脉在胰腺期、门静脉期与动脉期相比差异有显著性(0.01)。55例不可切除的肿瘤中，血管受侵者32例(58.18%),其中胰周小静脉扩张者19例(34.54%)。40例术前认为可切除的肿瘤，术中仍有7例不可切除。结论 多层螺旋CT双期扫描诊断胰腺癌，胰腺期和门静脉期应作为首选方案，具有非常重要的临床意义。 【关键词】 胰腺癌;X线计算机;体层摄影术;术前评估 　　Abstract： Objective To investigate the clinical value of multislice spiral CT (MSCT) scanning in the diagnosis of pancreatic adenocarcinoma. Methods 88 patients with pancreatic adenocarcinoma underwent triple-phase spiral CT scanning 18-25 seconds, 40-45 seconds and 60 seconds after the injection of contrast medium for angiography. Normal pancreatic tissues and the tumor were compared by normal scanning and triple-phase spiral CT scanning so as to explore the variations in enhanced scanning. The diagnosis of pancreatic tumor was based on the MSCT findings, which were assessed preoperatively and later compared with the surgical results. Results Density difference of normal pancreas was greatest on images obtained in the pancreatic phase (F=12.22,0.01); mean tumor-gland attenuation difference was the greatest on those obtained in the pancreatic phase (F=14.91,0.01). Tumor and peripancreatic vasculature were well visualized in the pancreatic phase. For vessels detection, sensitivity of arteries obtained in the arterial and pancreatic phases was superior to that of those obtained in portal vein phase (0.01); sensitivity of veins obtained in pancreatic and hepatic phases was better than that of those obtained in arterial phase (0.01). Vascular invasion of 32 cases were detected among 55 unresectable cases (58.18%), of which 19 cases with expansion of small veins were detected (34.54%). Of 40 cases which had been preoperatively diagnosed as resectable,