• 四川大學(xué)華西醫(yī)院放射科(成都 610041);

目的  探討胰腺癌血管侵犯的CT分級標(biāo)準(zhǔn)。方法  在CNKI及PubMed上檢索并復(fù)習(xí)近10年來關(guān)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(jié)果  多層螺旋CT是判斷胰腺癌可切除性的最佳影像學(xué)方法。目前主要的胰周血管侵犯CT分級標(biāo)準(zhǔn)包括： 根據(jù)腫瘤和血管間關(guān)系的CT分級標(biāo)準(zhǔn)、根據(jù)腫瘤包繞血管程度的CT分級標(biāo)準(zhǔn)、根據(jù)管腔狹窄程度的CT分級標(biāo)準(zhǔn)及聯(lián)合受侵血管狹窄程度與腫瘤包繞血管程度的CT分級標(biāo)準(zhǔn)。結(jié)論  胰腺癌血管侵犯的CT分級標(biāo)準(zhǔn)還不統(tǒng)一，每個標(biāo)準(zhǔn)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(shù)前評價. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(11): 939-943. doi: 復(fù)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(tǒng) [Ｊ]. 中國醫(yī)學(xué)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(shù)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(xué)新技術(shù)在消化系統(tǒng)的臨床應(yīng)用 [Ｊ]. 中國普外基礎(chǔ)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(wèi)峰, 陸勇, 林曉珠, 等. 胰腺癌血管侵犯的不同CT診斷標(biāo)準(zhǔn)的研究 [Ｊ]. 中國醫(yī)學(xué)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(biāo)準(zhǔn)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(xué)與腹部外科學(xué)的關(guān)系 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2003; 10(1): 62-63.
  1. 1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2009 [Ｊ]. CA Cancer J Clin, 2009; 59(4): 225-249.
  2. 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. 3. Standing S Ed. Gray’s Anatomy-The Anatomical Basis of Clinical Practice [M]. 39th eds. Elsevier: Churchill Livingstone, 2004: 1223-1225.
  4. 4. Chong M, Freeny PC, Schmiedl UP. Pancreatic arterial anatomy: depiction with dual-phase helical CT [Ｊ]. Radiology, 1998; 208(2): 537-542.
  5. 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. 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. 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. 8. 宋彬, 徐雋, 閔鵬秋. 胰腺的血管系統(tǒng) [Ｊ]. 中國醫(yī)學(xué)計算機成像雜志, 2002; 8(4): 217-222.
  9. 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. 10. Balachandran A, Darden DL, Tamm EP, et al. Arterial variants in pancreatic adenocarcinoma [Ｊ]. Abdom Imaging, 2008; 33(2): 214-221.
  11. 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. 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. 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. 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(shù)前評估中的價值 [Ｊ]. 癌癥進展雜志, 2008; 6(5): 504-509.
  15. 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. 16. 吳苾, 宋彬. 影像學(xué)新技術(shù)在消化系統(tǒng)的臨床應(yīng)用 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(2): 222-229.
  17. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 33. 宋衛(wèi)峰, 陸勇, 林曉珠, 等. 胰腺癌血管侵犯的不同CT診斷標(biāo)準(zhǔn)的研究 [Ｊ]. 中國醫(yī)學(xué)計算機成像雜志, 2007; 13(1): 32-36.
  34. 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. 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. 36. 李卉, 周康榮, 靳大勇, 等. 胰腺癌侵犯胰周動靜脈CT診斷標(biāo)準(zhǔn)的臨床價值 [Ｊ]. 中華腫瘤雜志, 2007; 29(2): 147-150.
  37. 37. 宋彬, 周翔平. 腹部影像學(xué)與腹部外科學(xué)的關(guān)系 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2003; 10(1): 62-63.