中晚期胰腺癌CT及MRI诊断.docVIP

中晚期胰腺癌CT及MRI诊断 　 作者：张世科，江海燕，关天明 【关键词】 胰腺癌；体层摄影术/X线计算机；磁共振成像 　　［摘 要］ 目的：探讨中晚期胰腺癌的CT和MRI诊断价值。方法：回顾性分析34例经手术或病理证实的中晚期胰腺癌患者的CT和MRI检查资料。结果：中晚期胰腺癌的影像表现为胰腺肿块，肿块与正常肝实质相比，在T1加权像呈低信号，T2加权像呈高信号，CT平扫呈低密度，MRI信号强度和CT密度不均匀，增强扫描轻度强化，可见坏死及囊变，胰、胆管扩张，双管征，邻近血管和脏器受侵，肝脏和腹膜后淋巴结转移。结论：CT和MRI检查对中晚期胰腺癌的诊断及鉴别诊断具有重要意义，可判断手术可切除性和预后。 　　［关键词］ 胰腺癌；体层摄影术/X线计算机；磁共振成像 　　CT and MRI Diagnosis of Late and Midtrimester Pancreatic Cancer 　　Abstract：Objective To study the diagnostic value of CT and MRI on late and midtrimester pancreatic cancer.Methods MRI findings of pancreatic cancer in 34 cases were analyzed retrospectively.Results The imaging feature of late and midtrimester pancreatic cancer was pancreatic mass.The pancreatic caner mass showed slightly low signal on T1WI and slightly high signal on T2WI compared with the liver parenchyma.On plain CT scan,the pancreatic caner mass showed hyperdensity.The MR signal and CT density were nonhomogeneous.There was slightly enhancement when contrast was given.The necrosis and cystic changing,double canal sign and cholangiectasis can be seen.The IVC and the superior mesenteric artery and vein can be invasived.Heptic hilum and retroperitoneal lymph nodes metastases.Conclusion MRI examination had importmant value on the diagnosis and differential diagnosis of late and midtrimester pancreatic cancer,the probability of surgery operation and the prognosis of the patients. 　　Key words：Pancreatic cancer；Xray/Computed tomography；Magnetic resonance imaging 　　胰腺癌约占胰腺恶性肿瘤的75%~90%，近年来发病率有逐渐增高的趋势。由于胰腺癌位置隐蔽和早期无症状，早期诊断困难。本文回顾分析我院及广州南方医院经手术病理证实的34例胰腺癌病例CT及MRI检查资料，以提高对本病的诊断认识。 　　1 资料和方法 　　1.1 一般资料 经手术病理证实的34胰腺癌患者，最小年龄46岁，最大年龄86岁，平均年龄62岁，男21例，女13例。临床主要表现：腹痛、体重下降、恶心、纳差、乏力、背痛。胰头癌患者多有无痛性黄疸，胰体尾癌多背痛明显。确诊后自然病程短于1 a。 　　1.2 仪器设备和检查方法 CT扫描设备采用Somatom Plus4及Prospeed All全身CT机，34例均做平扫和增强扫描，扫描层厚=层距＝5 mm，对比剂为尤维显。MR扫描采用SIEMENS公司Somatom Plus Vision1.5T和Magnetomc 0.35T全身MR扫描仪。34例行平扫，其中24例做GdDTPA增强扫描，扫描层厚8 mm，间隔1 mm，常规作轴位和冠状位扫描，序列为用自旋回波（SE）和快速自旋回波（TSE），分别获得T1加权像和T2加权像及脂肪抑制T2像。 　　2 结果 　　34例中胰头部肿块