A Clinical Study Of The Assessment Of Respectability Of Pancreatic Carcinoma With Multi-slice Spiral CT Angiography

Background: Pancreatic carcinoma is one of the most malignant tumors in alimentary tract; the incidence of a disease is increasing with years. There are no obvious symptoms, no particularity, high grade malignancy, strong invasive, early transfer and high mortality rate in pancreatic carcinoma. Recently, one of the best ways to cure disease and lengthen life is radical surgery; so the study to pancreatic carcinoma should be focused on early detection, the accurate assessment of respectability before surgery and the staging of tumor in order not to miss the best timing of surgery. Using multi-slice CT angiography (multi-slice spiral angiography, MSCTA) pancreatic carcinoma patients whether peripancreatic vascular invasion, provides an important basis for the staging of pancreatic carcinoma, and then determine the respectability of pancreatic carcinoma. We aim to highlight the MSCTA convenient, fast, high resolution, and peripancreatic vascular invasion in pancreatic performance characteristics of CT analysis, the diagnosis of pancreatic carcinoma, treatment has important reference value.Objective: To evaluate spiral CT angiography of pancreatic vascular invasion and respectability assessment of clinical value.Methods: A retrospective analysis in February 2007 ~ February 2010 Department of Surgery in our hospital treated 36 patients with pancreatic carcinoma with multislice spiral CT examination and surgical treatment, of which 27 cases of 64-slice spiral CT plain and enhanced scan routine 320 9 spiral plain and enhanced CT scans. Two-phase dynamic scanning line, of which the arterial phase scan time of 30 seconds, portal venous phase scan time of 60 seconds. And application of multi-planar volume reconstruction (MPR), surface reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) of four methods of three-dimensional reconstruction of peripancreatic vessels. According to Li Hui, Lu and other studies of vascular invasion grading standards violations per pancreatic vascular evaluation, assessment of main blood vessels were: hepatic artery (HA), celiac (CA), superior mesenteric artery (SMA), portal vein (PV), superior mesenteric vein (SMV). Statistical analysis using SPSS 13.0 statistical analysis software to calculate the overall vascular MSCTA evaluate the accuracy, specificity and sensitivity, and compared with surgical findings, Kappa coefficient calculation, compared MSCTA assessment and surgical outcome of consistency.Results: In this group of 36 cases receiving surgical treatment of pancreatic carcinoma patients, tumors in the pancreatic head and neck in 24 patients (66.7%), tumors in the pancreatic body in 8 cases (22.2%), tumors in the pancreatic tail tumor in 3 cases (8.3%), all pancreatic carcinoma in 1 case (3.8%). The largest cross-sectional diameter of tumor: one case located in the head by the maximum diameter of <2. 0 cm, 24 cases were in 2. 0-5. 0 cm, 11 cases> 5.0cm. All patients had surgery or intraoperative biopsy confirmed pancreatic Aden carcinoma. 12 cases completely radical surgery, MSCTA assessments are correct in 11 cases, one case of assessment of tumor invasion MSCTA SMA is not removed, but the operation proved respectability; in 24 cases laparoscopy or palliative surgery, MSCTA assessed correctly in 19 cases, five cases of patients CT assessment of respectability before, including four cases of vascular invasion are undervalued, and 1 case of liver metastasis before surgery missed. All patients were assessed a total of 108 arteries, MSCTA assessment of 17 arterial invasion in the 16 invasion, assessment of 91 arteries in 90 without invasion not overestimate underestimate the one, the accuracy of their assessment of arterial invasion of 98.1%, specificity 98.9%, sensitivity 94.1%; assessment vein of 72, MSCTA assessment of venous invasion in all 25 invasion, assessment of 47 veins in 44 without invasion is not invaded, three intravenous be underestimated, the accuracy of their judgments vein invasion in 95.8%, specificity 100%, sensitivity 89.3%; assess the overall total of 180 vessels, MSCTA determine vascular invasion in 41 of 42 vessel invasion, blood vessel is not to judge 138 vascular invasion in the 134 is not invasion, a blood vessel is undervalued, overvalued four vessels to determine the overall accuracy of vascular invasion in 97.2%, specificity 99.3%, sensitivity of 91.1%. The Kappa coefficient was 0.924, MSCTA overall assessment of whether the violation of pancreatic and per pancreatic vascular surgery no significant difference in judgments (P> 0.05), MSCTA assessment and surgery to check consistency. Per pancreatic arteries and veins have different performance characteristics of CT: more likely than venous and arterial wall and lumen change, including 4 cases with arterial contact surface is greater than 1 / 2 not appear to change the artery wall and lumen, 7 tumors with vein contact surface is less than 1 / 2 occurs when the wall and lumen venous changes, and venous been invaded, prone to pancreatic Zhou Xiaojing pulse expansion and collateral circulation.Conclusion: 1. Multi-slice CT angiography (MSCTA) rapid, accurate, high resolution, a strong spatial sense, is to understand the situation of pancreatic vessels noninvasive method. 2. Determine tumor invasion of per pancreatic arteries criteria:â‘ tumor artery with the arterial contact surface perimeter greater than 1 / 2, and luminal narrowing of the arterial wall or coarse;â‘¡tumor completely surrounded within the artery or arteries without contrast agent. Determine tumor invasion of per pancreatic veins criteria:â‘ interface between tumor and venous vein circumference greater than 1 / 2;â‘¡coarse vein wall;â‘¢vein stenosis;â‘£tumor completely surrounding the vein or vein lumen without contrast agent. Pancreatic arteries and veins of different diagnostic criteria to improve the accuracy of diagnosis.3.MSCTA Pancreatic violation of the high accuracy of per pancreatic vessels, provide an important basis for the staging of pancreatic carcinoma, and then determine the respectability of pancreatic carcinoma, pancreatic carcinoma diagnosis and treatment of important reference value.