Imaging diagnosis of pancreatic cancer and preoperative imaging evaluation of resectability and staging
-
摘要: 胰腺癌是一种高病死率的侵袭性恶性肿瘤。多层螺旋CT血管成像作为首选的胰腺成像手段,可评判胰周主要血管是否受侵、受侵范围和程度,为肿瘤分期、手术可切除性评估等提供可靠依据。MRI为CT的一种重要补充检查手段,对疾病诊断、肝转移和预后评估有重要的指导价值。胰腺癌血管侵犯情况是术前评估胰腺癌是否可切除的主要指标。淋巴结转移、远处转移、胰腺癌周围神经受侵及肝动脉变异等因素均会影响患者预后。指出胰腺癌患者的术前影像学评估对治疗方案制订、术式选择及预后判断具有指导意义。
-
关键词:
- 胰腺肿瘤 /
- 体层摄影术,螺旋计算机 /
- 磁共振成像 /
- 可切除性 /
- 肿瘤分期
Abstract: Pancreatic cancer is an invasive malignant tumor with a high mortality rate. As the preferred imaging method for pancreatic imaging,multi- slice CT angiography can evaluate the presence or absence,extent,and degree of invasion of peripancreatic major vessels to provide reliable evidence for tumor staging and surgical resectability evaluation. As an important supplementary method of CT,magnetic resonance imaging has an important guiding value in disease diagnosis,liver metastasis,and prognostic evaluation. Vascular invasion of pancreatic cancer is the main indicator for preoperative evaluation of respectability. Lymph node metastasis,distant metastasis,neural invasion of pancreatic cancer,and hepatic artery abnormalities are influencing factors for patients' prognosis. It is pointed out that preoperative imaging evaluation for patients with pancreatic cancer has guiding significance for the development of treatment regimens,selection of surgical procedures,and prognostic evaluation. -
[1]SIEGEL RL,MILLER KD,JEMAL A.Cancer statistics,2016[J].CA Cancer J Clin,2016,66(1):7-30. [2]RAHIB L,SMITH BD,AIZENBERG R,et al.Projecting cancer incidence and deaths to 2030:the unexpected burden of thyroid,liver,and pancreas cancers in the United States[J].Cancer Res,2014,74(11):2913-2921. [3]BONOMI A,SORDI V,DUGNANI E,et al.Gemcitabine-releasing mesenchymal stromal cells inhibit in vitro proliferation of human pancreatic carcinoma cells[J].Cytotherapy,2015,17(12):1687-1695. [4]KLAASSEN R,BENNINK RJ,van TIENHOVEN G,et al.Feasibility and repeatability of PET with the hypoxia tracer[(18)F]HX4 in oesophageal and pancreatic cancer[J].Radiother Oncol,2015,116(1):94-99. [5]MACARI M,SPIELER B,KIM D,et al.Dual-source dual-energy MDCT of pancreatic adenocarcinoma:initial observations with data generated at 80 k Vp and at simulated weighted-average 120k Vp[J].AJR Am J Roentgenol,2010,194(1):w27-w32. [6]YU SP,XIN J,XU WN,et al.Analysis of 18F-FDG PET/CT and enhanced CT in evaluation of resectability of pancreatic cancer[J].J Mod Oncol,2012,20(6):1221-1224.(in Chinese)于树鹏,辛军,徐微娜,等.18F-FDG PET/CT与增强CT对胰腺癌可切除性评估价值分析[J].现代肿瘤医学,2012,20(6):1221-1224. [7]Group of Pancreas Surgery,Chinese Society of Surgery,Chinese Medical Association.Guidelines for the management of pancreatic cancer(2014)[J].J Clin Hepatol,2014,30(12):1240-1245.(in Chinese)中华医学会外科学分会胰腺外科学组.胰腺癌诊治指南(2014)[J].临床肝胆病杂志,2014,30(12):1240-1245. [8]KITAHASHI T,MUTOH M,TSURUSAKI M,et al.Imaging study of pancreatic ductal adenocarcinomas in Syrian hamsters using X-ray micro-computed tomography(CT)[J].Cancer Science,2010,101(7):1761-1766. [9]KAWADA N,UEHARA H,KATAYAMA K,et al.Diagnostic clues and subsequent examinations that detected small pancreatic cancer[J].Hepatogastroenterology,2012,59(118):1665-1669. [10]PARK MJ,KIM YK,CHOI SY,et al.Preoperative detection of small pancreatic carcinoma:value of adding diffusion-weighted imaging to conventional MR imaging for improving confidence level[J].Radiology,2014,273(2):433-443. [11]MASTORAKI A,CHATZIMAVRIDOU-GRIGORIADOU V,CHATZIPETROU V,et al.Familial pancreatic cancer:challenging diagnostic approach and therapeutic management[J].J Gastrointest Cancer,2014,45(3):256-261. [12]AL-HAWARY MM,FRANCIS IR,CHARI ST,et al.Pancreatic ductal adenocarcinoma radiology reporting template:consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association[J].Radiology,2014,270(1):248-260. [13]SIEGEL R,MA J,ZOU Z,et al.Cancer statistics,2014[J].CA Cancer J Clin,2014,64(1):9-29. [14]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. [15]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. [16]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. [17]BUCHS NC,CHILCOTT M,POLETTI PA,et al.Vascular invasion in pancreatic cancer:imaging modalities,preoperative diagnosis and surgical management[J].World J Gastroenterol,2010,16(7):818-831. [18]YIN YJ,ZENG MS,LI H,et al.Pancreatic carcinoma invasion to peripancreatic vessels:evaluation the resectability with MRI[J].J Clin Radiol,2005,24(9):792-795.(in Chinese)殷允娟,曾蒙苏,李卉,等.MRI对胰腺癌胰周血管侵犯的手术可切除性评价[J].临床放射学杂志,2005,24(9):792-795. [19]LI H,ZENG MS,ZHOU KR,et al.The CT signs of peripancreatic vascular invasion in pancreatic carcinoma[J].Chin J Radiol,2005,39(3):293-297.(in Chinese)李卉,曾蒙苏,周康荣,等.胰腺癌侵犯胰周主要血管的CT表现分析[J].中华放射学杂志,2005,39(3):293-297. [20]LI XB,TIAN JM,WANG PJ,et al.Dual-phases angiography of pancreas with multi-slice helical CT[J].Chin J Med Imaging Technol,2002,18(5):428-430.(in Chinese)李晓兵,田建明,王培军,等.多层螺旋CT胰腺双期血管成像研究[J].中国医学影像技术,2002,18(5):428-430. [21]LI MS,MENG FQ.The reasons of underestimating the extent of pancreatic cancer invasion of peripancreatic vessels through imaging[J].J Pract Radiol,2016,32(1):45-47,55.(in Chinese)李明山,孟凡琴.胰周血管受胰腺癌侵犯程度常被影像学低估的原因分析[J].实用放射学杂志,2016,32(1):45-47,55. [22]ASSIFI MM,LU X,EIBL G,et al.Neoadjuvant therapy in pancreatic adenocarcinoma:a meta-analysis of phase II trials[J].Surgery,2011,150(3):466-473. [23]CASSINOTTO C,MOURIES A,LAFOURCADE JP,et al.Locally advanced pancreatic adenocarcinoma:reassessment of response with CT after neoadjuvant chemotherapy and radiation therapy[J].Radiology,2014,273(1):108-116. [24]KATZ MH,FLEMING JB,BHOSALE P,et al.Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators[J].Cancer,2012,118(23):5749-5756. [25]FERRONE CR,MARCHEGIANI G,HONG TS,et al.Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer[J].Ann Surg,2015,261(1):12-17. [26]XIAO Z,LUO G,LIU C,et al.Molecular mechanism underlying lymphatic metastasis in pancreatic cancer[J].Biomed Res Int,2014,2014:925845. [27]LIU ZQ,XIAO ZW,LUO GP,et al.Effect of the number of positive lymph nodes and lymph node ratio on prognosis of patients after resection of pancreatic adenocarcinoma[J].Hepatobiliary Pancreat Dis Int,2014,13(6):634-641. [28]PAI RK,BECK AH,MITCHEM J,et al.Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma:direct lymph node invasion has similar survival to node-negative disease[J].Am J Surg Pathol,2011,35(2):228-234. [29]LUO GP,NI QX,YU XJ.Clinical application value of lymph node ratio in pancreatic cancer[J].Chin J Dig Surg,2015,14(8):686-688.(in Chinese)罗国培,倪泉兴,虞先濬.胰腺癌中淋巴结转移率的临床应用价值[J].中华消化外科杂志,2015,14(8):686-688. [30]MACK MG,RIEGER J,BAGHI M,et al.Cervical lymph nodes[J].Eur J Radiol,2008,66(3):493-500. [31]KING AD,TSE GM,AHUJA AT,et al.Necrosis in metastatic neck nodes:diagnostic accuracy of CT,MR imaging,and US[J].Radiology,2004,230(3):720-726. [32]FONG ZV,TAN WP,LAVU H,et al.Preoperative imaging for resectable periampullary cancer:clinicopathologic implications of reported radiographic findings[J].J Gastrointest Surg,2013,17(6):1098-1106. [33]WANG L,LIU LH,HAN C,et al.A comparative study of computed tomography and magnetic resonance imaging in pathological diagnosis of regional lymph node metastasis[J].Chin J Radiat Oncol,2015,24(5):493-496.(in Chinese)王澜,刘丽虹,韩春,等.依据CT及MRI确定区域淋巴结转移的病理对照研究[J].中华放射肿瘤学杂志,2015,24(5):493-496. [34]LOW G,PANU A,MILLO N,et al.Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas[J].Radiographics,2011,31(4):993-1015. [35]MOTOSUGI U,ICHIKAWA T,MORISAKA H,et al.Detection of pancreatic carcinoma and liver metastases with gadoxetic acid-enhanced MR imaging:comparison with contrast-enhanced multidetector row CT[J].Radiology,2011,260(2):446-453. [36]LEE KH,LEE JM,PARK JH,et al.MR imaging in patients with suspected liver metastases:value of liver-specific contrast agent gadoxetic acid[J].Korean J Radiol,2013,14(6):894-904. [37]DAI H,LI R,WHEELER T,et al.Enhanced survival in perineural invasion of pancreatic cancer:an in vitro approach[J].Hum Pathol,2007,38(2):299-307. [38]DESHMUKH SD,WILLMANN JK,JEFFREY RB.Pathways of extrapancreatic perineural invasion by pancreatic adenocarcinoma:evaluation with 3D volume-rendered MDCT imaging[J].AJR Am J Roentgenol,2010,194(3):668-674. [39]MOCHIZUKI K,GABATA T,KOZAKA K,et al.MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma:correlation with en bloc pathological specimens and diagnostic accuracy[J].Eur Radiol,2010,20(7):1757-1767. [40]ZUO HD,TANG W,ZHANG XM,et al.CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus(Part II):imaging of pancreatic carcinoma nerve invasion[J].World J Radiol,2012,4(1):13-20. [41]HAYANO K,MIURA F,AMANO H,et al.Correlation of apparent diffusion coefficient measured by diffusion-weighted MRI and clinicopathologic features in pancreatic cancer patients[J].J Hepatobiliary Pancreat Sci,2013,20(2):243-248. [42]SHUKLA PJ,BARRETO SG,KULKARNI A,et al.Vascular anomalies encountered during pancreatoduodenectomy:do they influence outcomes?[J].Ann Surg Oncol,2010,17(1):186-193. [43]MICHELS NA.Newer anatomy of the liver and its variant blood supply and collateral circulation[J].Am J Surg,1966,112(3):337-347. [44]LU C,LIU ZQ.The imaging study of hepatic arterial variations[J].Chin J Interv Imaging Ther,2006,3(2):84-87.(in Chinese)卢川,刘作勤.肝动脉解剖变异影像学研究[J].中国介入影像与治疗学,2006,3(2):84-87.
本文二维码
计量
- 文章访问数: 2436
- HTML全文浏览量: 19
- PDF下载量: 450
- 被引次数: 0