A new approach for evaluating the resectability of pancreatic and periampullary neoplasms
A new approach for evaluating the resectability of pancreatic and periampullary neoplasms
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评估胰腺和壶腹周围肿瘤可切除性的新方法
DOI：
10.1016/j.pan.2012.05.006
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发表时间：
2012-07-01
期刊：
影响因子：
3.6
通讯作者：
Zhong, Shi Zheng
中科院分区：
文献类型：
--
作者：
Fang, Chi-hua;Zhu, Wen;Zhong, Shi Zheng
目的：建立医学图像三维可视化系统（MI-3DVS）评估胰腺及壶腹周围肿瘤可切除性的新标准。方法：对80例胰腺及壶腹周围肿瘤进行检查。 64 层多排 CT (64-MDCT) 图像和患者数据由 MI-3DVS 处理。 MI-3DVS检查的主要内容包括肿瘤的形状、大小和位置；相关船舶的分布；大血管的管腔形态；胰周小静脉的分布和形态；胆胰管的形态、扩张程度和阻塞部位。根据MI-3DVS检查结果的血管特征，将病例分为五种类型。 II型是可切除的，III型是潜在可切除的或可联合血管切除和重建切除的，IV型和V型是不可切除的。然后将结果与相应的CT血管造影（CTA）分析和实际手术观察进行比较。结果：80例中，MI-3DVS显示60例可切除，其余20例不可切除。相比之下，CTA 显示 50 例可切除病例和 30 例不可切除病例。对于57例胰腺导管癌和全部80例壶腹周围肿瘤，MI-3DVS评估的阳性预测值为100%，阴性预测值为100%，敏感性为100%，特异性为100%，准确性为100%。而CTA则生成相应的值96%、60%、80%、90%、82.5%。两种方法总体差异显着（P < 0.05）。结论：新的分类系统能够可靠地评估胰腺和壶腹周围肿瘤的可切除性。版权所有 (c) 2012，IAP 和 EPC。由 Reed Elsevier India Pvt. 旗下子公司 Elsevier India 出版。有限公司保留所有权利。
Objective: To establish a new standard for assessing the resectability of pancreatic and periampullary tumors by the Medical Image Three-Dimensional Visualization System (MI-3DVS).Methods: Eighty cases of pancreatic and periampullary tumors were examined. The 64-slice multi-detector CT (64-MDCT) images and patient data were processed by MI-3DVS. The main elements examined by MI-3DVS included tumor shape, size, and location; distribution of related vessels; luminal morphology of large vessels; distribution and morphology of the small peripancreatic veins; morphology, degree of dilation, and obstructive sites of bile and pancreatic ducts. Based on vascular characteristics of MI-3DVS findings, the cases were classified into five types. Type land II were resectable, type III were potentially resectable or resectable with combined vascular resection and reconstruction, and type IV and V were unresectable. The outcome was then compared with corresponding CT angiography (CTA) analysis and actual surgical observations.Results: Among the 80 cases, MI-3DVS indicated that 60 were resectable and the remaining 20 were not. In contrast, CTA indicated 50 resectable cases and 30 unresectable cases. For 57 cases of pancreatic ductal carcinomas and all 80 cases periampullaiy tumors, MI-3DVS assessment yielded a positive predictive value of 100%, negative predictive value of 100%, a sensitivity of 100%, a specificity of 100%, and an accuracy of 100%. While CTA generated corresponding values of 96%, 60%, 80%, 90%, 82.5%. The overall differences between the two methods were significant (P < 0.05).Conclusion: The new classification system is able to reliably assess the resectability of pancreatic and periampullary tumors. Copyright (c) 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.