胰腺癌血管侵犯的CT術前評價_《中國普外基礎與臨床雜志》

作者：

黃子星 , 陳光文 , 宋彬

四川大學華西醫院放射科(成都 610041);

關鍵詞：

胰腺癌血管侵犯斷層攝影術/X線計算機多層螺旋CT 解剖血管成像術前評價

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目的探討胰腺癌血管侵犯的CT分級標準。方法在CNKI及PubMed上檢索并復習近10年來關于CT評價胰腺癌侵犯胰周血管的文獻，對CT評價胰腺癌血管侵犯程度的價值進行綜述。結果多層螺旋CT是判斷胰腺癌可切除性的最佳影像學方法。目前主要的胰周血管侵犯CT分級標準包括：根據腫瘤和血管間關系的CT分級標準、根據腫瘤包繞血管程度的CT分級標準、根據管腔狹窄程度的CT分級標準及聯合受侵血管狹窄程度與腫瘤包繞血管程度的CT分級標準。結論胰腺癌血管侵犯的CT分級標準還不統一，每個標準都有缺陷。

引用本文： 黃子星,陳光文,宋彬. 胰腺癌血管侵犯的CT術前評價. 中國普外基礎與臨床雜志, 2009, 16(11): 939-943. doi: 復制

1.	Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [Ｊ]. CA Cancer J Clin, 2009; 59(4): 225-249.
2.	Katz MH, Hwang R, Fleming JB, et al. Tumor-node-metastasis staging of pancreatic adenocarcinoma [Ｊ]. CA Cancer J Clin, 2008; 58(2): 111-125.
3.	Standing S Ed. Gray’s Anatomy-The Anatomical Basis of Clinical Practice [M]. 39th eds. Elsevier: Churchill Livingstone, 2004: 1223-1225.
4.	Chong M, Freeny PC, Schmiedl UP. Pancreatic arterial anatomy: depiction with dual-phase helical CT [Ｊ]. Radiology, 1998; 208(2): 537-542.
5.	National Comprehensive Cancer Network. NCCN clinical pr-actice guidelines in oncologyTM: pancreatic adenocarcainoma.V.1.2009 [EB/OL]. http: www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf, 2009-11-16.
6.	Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2006; 20(2): 227-251.
7.	Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis [Ｊ]. J Comput Assist Tomogr, 2005; 29(4): 438-445.
8.	宋彬, 徐雋, 閔鵬秋. 胰腺的血管系統 [Ｊ]. 中國醫學計算機成像雜志, 2002; 8(4): 217-222.
9.	Vedantham S, Lu DS, Reber HA, et al. Small peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT [Ｊ]. AJR Am J Roentgenol, 1998; 170(2): 377-383.
10.	Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma [Ｊ]. Abdom Imaging, 2008; 33(2): 214-221.
11.	Yang SH, Yin YH, Jang JY, et al. Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion [Ｊ]. World J Surg, 2007; 31(12): 2384-2391.
12.	Volpe CM, Peterson S, Hoover EL, et al. Justification for visceral angiography prior to pancreaticoduodenectomy [Ｊ]. Am Surg, 1998; 64(8): 758-761.
13.	Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT [Ｊ]. Radiology, 2003; 229(1): 81-90.
14.	張紅梅, 周純武, 趙心明, 等. 多層螺旋CT三期增強掃描在胰腺癌術前評估中的價值 [Ｊ]. 癌癥進展雜志, 2008; 6(5): 504-509.
15.	Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement [Ｊ]. Ann Surg Oncol, 2009; 16(7): 1727-1733.
16.	吳苾, 宋彬. 影像學新技術在消化系統的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(2): 222-229.
17.	Mehmet Erturk S, Ichikawa T, Sou H, et al. Pancreatic adenocarcinoma: MDCT versus MRI in the detection and assessment of locoregional extension [Ｊ]. J Comput Assist Tomogr, 2006; 30(4): 583-590.
18.	Kawamoto S, Lawler LP, Horton KM, et al. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma [Ｊ]. AJR Am J Roentgenol, 2006; 186(3): 687-695.
19.	Tamm EP, Loyer EM, Faria S, et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy [Ｊ]. Abdom Imaging, 2006; 31(5): 568-574.
20.	Tamm EP, Loyer EM, Faria SC, et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer [Ｊ]. Abdom Imaging, 2007; 32(5): 660-667.
21.	Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT [Ｊ]. Abdom Imaging, 1996; 21(3): 202-206.
22.	Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT [Ｊ]. AJR Am J Roentgenol, 1997; 168(6): 1439-1443.
23.	O’Malley ME, Boland GW, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT [Ｊ]. AJR Am J Roentgenol, 1999; 173(6): 1513-1518.
24.	Phoa SS, Reeders JW, Stoker J, et al. CT criteria for venous invasion in patients with pancreatic head carcinoma [Ｊ]. Br J Radiol, 2000; 73(875): 1159-1164.
25.	Brügel M, Rummeny EJ, Dobritz M. Vascular invasion in pancreatic cancer: value of multislice helical CT [Ｊ]. Abdom Imaging, 2004; 29(2): 239-245.
26.	Mazzeo S, Cappelli C, Caramella D, et al. Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology [Ｊ]. Abdom Imaging, 2007; 32(6): 737-742.
27.	Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3): 492-501.
28.	Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy [Ｊ]. Ann Surg, 1996; 223(2): 134-140.
29.	Baek SY, Sheafor DH, Keogan MT, et al. Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques [Ｊ]. AJR Am J Roentgenol, 2001; 176(6): 1467-1473.
30.	Legmann P, Vignaux O, Dousset B, et al. Pancreatic tu-mors: comparison of dual-phase helical CT and endoscopic sonography [Ｊ]. AJR Am J Roentgenol, 1998; 170(5): 1315-1322.
31.	Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery [Ｊ]. AJR Am J Roentgenol, 2002; 178(4): 821-826.
32.	Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results [Ｊ]. J Comput Assist Tomogr, 2001; 25(3): 337-342.
33.	宋衛峰, 陸勇, 林曉珠, 等. 胰腺癌血管侵犯的不同CT診斷標準的研究 [Ｊ]. 中國醫學計算機成像雜志, 2007; 13(1): 32-36.
34.	Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT [Ｊ]. Br J Radiol, 2006; 79(947): 880-887.
35.	Li H, Zeng MS, Zhou KR. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion [Ｊ]. J Comput Assist Tomogr, 2005; 29(2): 170-175.
36.	李卉, 周康榮, 靳大勇, 等. 胰腺癌侵犯胰周動靜脈CT診斷標準的臨床價值 [Ｊ]. 中華腫瘤雜志, 2007; 29(2): 147-150.
37.	宋彬, 周翔平. 腹部影像學與腹部外科學的關系 [Ｊ]. 中國普外基礎與臨床雜志, 2003; 10(1): 62-63.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [Ｊ]. CA Cancer J Clin, 2009; 59(4): 225-249.
2. Katz MH, Hwang R, Fleming JB, et al. Tumor-node-metastasis staging of pancreatic adenocarcinoma [Ｊ]. CA Cancer J Clin, 2008; 58(2): 111-125.
3. Standing S Ed. Gray’s Anatomy-The Anatomical Basis of Clinical Practice [M]. 39th eds. Elsevier: Churchill Livingstone, 2004: 1223-1225.
4. Chong M, Freeny PC, Schmiedl UP. Pancreatic arterial anatomy: depiction with dual-phase helical CT [Ｊ]. Radiology, 1998; 208(2): 537-542.
5. National Comprehensive Cancer Network. NCCN clinical pr-actice guidelines in oncologyTM: pancreatic adenocarcainoma.V.1.2009 [EB/OL]. http: www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf, 2009-11-16.
6. Michl P, Pauls S, Gress TM. Evidence-based diagnosis and staging of pancreatic cancer [Ｊ]. Best Pract Res Clin Gastroenterol, 2006; 20(2): 227-251.
7. Bipat S, Phoa SS, van Delden OM, et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resectability of pancreatic adenocarcinoma: a meta-analysis [Ｊ]. J Comput Assist Tomogr, 2005; 29(4): 438-445.
8. 宋彬, 徐雋, 閔鵬秋. 胰腺的血管系統 [Ｊ]. 中國醫學計算機成像雜志, 2002; 8(4): 217-222.
9. Vedantham S, Lu DS, Reber HA, et al. Small peripancreatic veins: improved assessment in pancreatic cancer patients using thin-section pancreatic phase helical CT [Ｊ]. AJR Am J Roentgenol, 1998; 170(2): 377-383.
10. Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma [Ｊ]. Abdom Imaging, 2008; 33(2): 214-221.
11. Yang SH, Yin YH, Jang JY, et al. Assessment of hepatic arterial anatomy in keeping with preservation of the vasculature while performing pancreatoduodenectomy: an opinion [Ｊ]. World J Surg, 2007; 31(12): 2384-2391.
12. Volpe CM, Peterson S, Hoover EL, et al. Justification for visceral angiography prior to pancreaticoduodenectomy [Ｊ]. Am Surg, 1998; 64(8): 758-761.
13. Fletcher JG, Wiersema MJ, Farrell MA, et al. Pancreatic malignancy: value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT [Ｊ]. Radiology, 2003; 229(1): 81-90.
14. 張紅梅, 周純武, 趙心明, 等. 多層螺旋CT三期增強掃描在胰腺癌術前評估中的價值 [Ｊ]. 癌癥進展雜志, 2008; 6(5): 504-509.
15. Callery MP, Chang KJ, Fishman EK, et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement [Ｊ]. Ann Surg Oncol, 2009; 16(7): 1727-1733.
16. 吳苾, 宋彬. 影像學新技術在消化系統的臨床應用 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(2): 222-229.
17. Mehmet Erturk S, Ichikawa T, Sou H, et al. Pancreatic adenocarcinoma: MDCT versus MRI in the detection and assessment of locoregional extension [Ｊ]. J Comput Assist Tomogr, 2006; 30(4): 583-590.
18. Kawamoto S, Lawler LP, Horton KM, et al. MDCT of intraductal papillary mucinous neoplasm of the pancreas: evaluation of features predictive of invasive carcinoma [Ｊ]. AJR Am J Roentgenol, 2006; 186(3): 687-695.
19. Tamm EP, Loyer EM, Faria S, et al. Staging of pancreatic cancer with multidetector CT in the setting of preoperative chemoradiation therapy [Ｊ]. Abdom Imaging, 2006; 31(5): 568-574.
20. Tamm EP, Loyer EM, Faria SC, et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer [Ｊ]. Abdom Imaging, 2007; 32(5): 660-667.
21. Loyer EM, David CL, Dubrow RA, et al. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT [Ｊ]. Abdom Imaging, 1996; 21(3): 202-206.
22. Lu DS, Reber HA, Krasny RM, et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT [Ｊ]. AJR Am J Roentgenol, 1997; 168(6): 1439-1443.
23. O’Malley ME, Boland GW, Wood BJ, et al. Adenocarcinoma of the head of the pancreas: determination of surgical unresectability with thin-section pancreatic-phase helical CT [Ｊ]. AJR Am J Roentgenol, 1999; 173(6): 1513-1518.
24. Phoa SS, Reeders JW, Stoker J, et al. CT criteria for venous invasion in patients with pancreatic head carcinoma [Ｊ]. Br J Radiol, 2000; 73(875): 1159-1164.
25. Brügel M, Rummeny EJ, Dobritz M. Vascular invasion in pancreatic cancer: value of multislice helical CT [Ｊ]. Abdom Imaging, 2004; 29(2): 239-245.
26. Mazzeo S, Cappelli C, Caramella D, et al. Evaluation of vascular infiltration in resected patients for pancreatic cancer: comparison among multidetector CT, intraoperative findings and histopathology [Ｊ]. Abdom Imaging, 2007; 32(6): 737-742.
27. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography [Ｊ]. Am J Gastroenterol, 2004; 99(3): 492-501.
28. Conlon KC, Dougherty E, Klimstra DS, et al. The value of minimal access surgery in the staging of patients with potentially resectable peripancreatic malignancy [Ｊ]. Ann Surg, 1996; 223(2): 134-140.
29. Baek SY, Sheafor DH, Keogan MT, et al. Two-dimensional multiplanar and three-dimensional volume-rendered vascular CT in pancreatic carcinoma: interobserver agreement and comparison with standard helical techniques [Ｊ]. AJR Am J Roentgenol, 2001; 176(6): 1467-1473.
30. Legmann P, Vignaux O, Dousset B, et al. Pancreatic tu-mors: comparison of dual-phase helical CT and endoscopic sonography [Ｊ]. AJR Am J Roentgenol, 1998; 170(5): 1315-1322.
31. Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery [Ｊ]. AJR Am J Roentgenol, 2002; 178(4): 821-826.
32. Nakayama Y, Yamashita Y, Kadota M, et al. Vascular encasement by pancreatic cancer: correlation of CT findings with surgical and pathologic results [Ｊ]. J Comput Assist Tomogr, 2001; 25(3): 337-342.
33. 宋衛峰, 陸勇, 林曉珠, 等. 胰腺癌血管侵犯的不同CT診斷標準的研究 [Ｊ]. 中國醫學計算機成像雜志, 2007; 13(1): 32-36.
34. Li H, Zeng MS, Zhou KR, et al. Pancreatic adenocarcinoma: signs of vascular invasion determined by multi-detector row CT [Ｊ]. Br J Radiol, 2006; 79(947): 880-887.
35. Li H, Zeng MS, Zhou KR. Pancreatic adenocarcinoma: the different CT criteria for peripancreatic major arterial and venous invasion [Ｊ]. J Comput Assist Tomogr, 2005; 29(2): 170-175.
36. 李卉, 周康榮, 靳大勇, 等. 胰腺癌侵犯胰周動靜脈CT診斷標準的臨床價值 [Ｊ]. 中華腫瘤雜志, 2007; 29(2): 147-150.
37. 宋彬, 周翔平. 腹部影像學與腹部外科學的關系 [Ｊ]. 中國普外基礎與臨床雜志, 2003; 10(1): 62-63.

《中國普外基礎與臨床雜志》

胰腺癌血管侵犯的CT術前評價

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《中國普外基礎與臨床雜志》

胰腺癌血管侵犯的CT術前評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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