Pancreatic adenocarcinoma
Pancreatic adenocarcinoma
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DOI：
10.1007/s00330-006-0435-7
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发表时间：
2007-03-01
影响因子：
5.9
通讯作者：
Goetzinger, Peter
中科院分区：
文献类型：
--
作者：
Schima, Wolfgang;Ba-Ssalamah, Ahmed;Goetzinger, Peter
腺癌是最常见的恶性胰腺肿瘤，60-70%的病例累及胰头。到确诊时，至少80%的肿瘤是不可切除的。螺旋计算机断层扫描（CT）在检测和分期腺癌方面非常有效，检测灵敏度高达90%，分期准确率为80-90%，但在检测小癌症方面存在局限性。此外，由于小的肝转移、腹膜癌转移和细微的血管浸润征象可能被遗漏，因此它在确定不可切除性方面并不十分准确。多排螺旋CT（MDCT）以其固有的三维可视化血管受累的能力带来了实质性的改进。已发现MDCT在检测腺癌方面至少等同于对比增强磁共振成像（MRI）。MRI可以作为一个解决问题的工具，在可疑的CT：MRI可以帮助排除陷阱，如炎性假瘤，局灶性脂肪增多症，脓肿，或囊性肿瘤。Mangafodipir增强的MRI显示了非常高的肿瘤-胰腺对比度，这有助于诊断小癌症。如果可用，超声内镜也是检测小癌症的非常准确的工具，灵敏度高达98%。如果需要进一步治疗的组织学诊断，这是图像引导活检的首选技术。
Adenocarcinoma is the most common malignant pancreatic tumor, affecting the head of the pancreas in 60-70% of cases. By the time of diagnosis, at least 80% of tumors are unresectable. Helical computed tomography (CT) is very effective in detecting and staging adenocarcinoma, with a sensitivity of up to 90% for detection and an accuracy of 80-90% for staging, but it has limitations in detecting small cancers. Moreover, it is not very accurate for determining nonresectability because small liver metastases, peritoneal carcinomatosis, and subtle signs of vascular infiltration may be missed. Multidetector-row CT (MDCT) has brought substantial improvements with its inherent ability to visualize vascular involvement in three dimensions. MDCT has been found to be at least equivalent to contrast-enhanced magnetic resonance imaging (MRI) for detecting adenocarcinoma. MRI can be used as a problem-solving tool in equivocal CT: MRI may help rule out pitfalls, such as inflammatory pseudotumor, focal lipomatosis, abscess, or cystic tumors. Mangafodipir-enhanced MRI reveals a very high tumor-pancreas contrast, which helps in diagnosing small cancers. Endosonography is, if available, also a very accurate tool for detecting small cancers, with a sensitivity of up to 98%. It is the technique of choice for image-guided biopsy if a histologic diagnosis is required for further therapy.