Diagnosis of pancreatic cancer.
Diagnosis of pancreatic cancer.
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DOI：
10.1080/13651820500540949
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Takeshita, Koji
中科院分区：
文献类型：
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作者：
Miura, Fumihiko;Takada, Tadahiro;Takeshita, Koji
随着超声造影(US)、螺旋CT(CT)、增强磁共振成像(MRI)和内窥镜超声(EUS)等诊断技术的进步，胰腺癌的诊断能力迅速提高。每种技术都有各自的优点和局限性，因此选择合适的诊断技术在目的和特征方面尤为重要。腹部超声通常是首先用来确定腹痛或黄疸的原因，而传统的超声诊断胰腺肿瘤的准确率只有50%-70%。CT是目前应用最广泛的胰腺癌诊断和分期的影像检查。胰腺癌在增强CT上通常表现为低密度区。据报道，螺旋CT显示胰腺癌的敏感性很高，在89%到97%之间。多排螺旋CT可提高胰腺癌的早期发现和准确分期。应该考虑的是，一些胰腺癌被描述为等密度的，胰腺炎合并胰腺癌有时可能导致对分期的高估。有报道称，脂肪抑制的T1加权自旋回波图像和增强的动态梯度回波MR图像在发现微小病变方面优于螺旋CT。然而，在动态Gd增强MRI上，慢性胰腺炎和胰腺癌并不是基于强化程度和时间来区分的。EUS对小肿瘤的检出优于螺旋CT和MRI，并能较高灵敏度地定位淋巴结转移或肿瘤血管侵犯。EUS引导下细针穿刺活检是一种安全、准确的诊断可疑胰腺癌的方法。(18)氟脱氧葡萄糖(FDG)正电子发射断层扫描(PET)被认为是一种有希望的无创鉴别良恶性病变的方法。已有研究报道FDG-PET诊断胰腺恶性肿瘤的敏感性为71-100%，特异性为-90%。FDG-PET不能替代形态成像，而是对形态成像的补充，因此，在可疑病例中，该方法必须与其他成像方式相结合。
The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71-100% and 64-90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities.