State-of-the-art Imaging in the Diagnosis and Treatment of Pancreatic Ductal Carcinoma: Current Role and Value
-
摘要: 胰腺导管腺癌(pancreatic ductal carcinoma, PDAC)是一种极为凶险、高度恶性的消化道肿瘤, 其诊治路径中的常见问题主要包括:(1)筛查和早期检出; (2)术前评估及准确分期; (3)鉴别诊断; (4)随访及治疗评估, 影像学在其中均扮演重要角色。本文总结各种影像学检查在PDAC诊治路径中的作用及价值, 深入了解各种影像学检查的优势和局限性, 提供基于证据的PDAC影像学检查流程, 并重点阐述PDAC影像诊断与鉴别诊断要点, 从而更好地指导临床决策, 改善PDAC患者预后。Abstract: Pancreatic ductal carcinoma(PDAC)is a highly malignant tumor of the digestive tract. The common problems in its diagnosis and treatment include:(1)screening and early detection; (2)accurate diagnosis and staging; (3)differential diagnosis; (4)follow-up and treatment evaluation, in which imaging plays an important role. This article summarized the role and value of various imaging examinations in the diagnosis and treatment of PDAC, explained the advantages and limitations of various imaging examinations, provided evidence-based PDAC imaging examination process, and focused on the key points of PDAC imaging diagnosis and differential diagnosis, so as to better guide clinical decision-making and improve the prognosis of patients with PDAC.
-
Key words:
- pancreatic ductal carcinoma /
- diagnosis and treatment /
- clinical pathway /
- imaging
利益冲突 无 -
[1] Siegel RL, Miller KD, Jemal A.Cancer statistics, 2018[J].CA Cancer J Clin, 2018, 68:7-30. [2] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J].CA Cancer J Clin, 2016, 66:115-132. [3] 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, 74:2913-2921. [4] Hanada K, Okazaki A, Hirano N, et al.Effective screening for early diagnosis of pancreatic cancer[J].Best Pract Res Clin Gastroenterol, 2015, 29:929-939. [5] Canto MI, Hruban RH, Fishman EK, et al.Frequent detection of pancreatic lesions in asymptomatic high-risk individuals[J].Gastroenterology, 2012, 142:796-804;quiz e14-e15. [6] Canto MI, Harinck F, Hruban RH, et al.International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer[J].Gut, 2013, 62:339-347. [7] 石娟, 董卫国.超声内镜引导下细针穿刺对胰腺癌的诊断价值[J].胃肠病学和肝病学杂志, 2018, 27:39-42. [8] Mensel B, Messner P, Mayerle J, et al.Secretin-stimulated MRCP in volunteers:assessment of safety, duct visualization, and pancreatic exocrine function[J].AJR Am J Roentgenol, 2014, 202:102-108. [9] 杨廷双.早期胰腺癌影像学诊断的研究进展[J].中国医学影像技术, 2009, 25:221-223. [10] 夏蜀珺, 郭俊超, 李建, 等.MicroRNAs在胰腺癌早期诊断中的应用[J].协和医学杂志, 2014, 5:210-212. [11] Bronstein YL, Loyer EM, Kaur H, et al.Detection of small pancreatic tumors with multiphasic helical CT[J].AJR Am J Roentgenol, 2004, 182:619-623. [12] McNamara MM, Little MD, Alexander LF, et al.Multireader evaluation of lesion conspicuity in small pancreatic adenocarcinomas:complimentary value of iodine material density and low keV simulated monoenergetic images using multiphasic rapid kVp-switching dual energy CT[J].Abdom Imaging, 2015, 40:1230-1240. [13] Brook OR, Gourtsoyianni S, Brook A, et al.Split-bolus spectral multidetector CT of the pancreas:assessment of radiation dose and tumor conspicuity[J].Radiology, 2013, 269:139-148. [14] Park HJ, Jang KM, Song KD, et al.Value of unenhanced MRI with diffusion-weighted imaging for detection of primary small (</=20 mm) solid pancreatic tumours and prediction of pancreatic ductal adenocarcinoma[J].Clin Radiol, 2017, 72:1076-1084. [15] Choi TW, Lee JM, Kim JH, et al.Comparison of Multidetector CT and Gadobutrol-Enhanced MR Imaging for Evaluation of Small, Solid Pancreatic Lesions[J].Korean J Radiol, 2016, 17:509-521. [16] Kitano M, Kudo M, Yamao K, et al.Characterization of small solid tumors in the pancreas:the value of contrast-enhanced harmonic endoscopic ultrasonography[J].Am J Gastroenterol, 2012, 107:303-310. [17] Kim JH, Park SH, Yu ES, et al.Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT:frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations[J].Radiology, 2010, 257:87-96. [18] Nguyen VX, Nguyen CC, Nguyen BD.18F-FDG PET/CT imaging of the pancreas:spectrum of diseases[J].Jop, 2011, 12:557-566. [19] Prokesch RW, Chow LC, Beaulieu CF, et al.Isoattenuating pancreatic adenocarcinoma at multi-detector row CT:secon-dary signs[J].Radiology, 2002, 224:764-768. [20] Blouhos K, Boulas KA, Tsalis K, et al.The isoattenuating pancreatic adenocarcinoma:Review of the literature and critical analysis[J].Surg Oncol, 2015, 24:322-328. [21] Khorana AA, Mangu PB, Berlin J, et al.Potentially Curable Pancreatic Cancer:American Society of Clinical Oncology Clinical Practice Guideline Update[J].J Clin Oncol, 2017, 35:2324-2328. [22] Tempero MA, Malafa MP, Al-Hawary M, et al.Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw, 2017, 15:1028-1061. [23] 中国抗癌协会胰腺癌专业委员会.胰腺癌综合诊治指南(2018版)[J].中华外科杂志, 2018, 56:481-494. [24] 杨红, 钱家鸣, 杨爱明, 等.不同影像学方法在胰腺癌诊断中的价值与比较[J].协和医学杂志, 2010, 1:137-140. [25] Varadhachary GR, Tamm EP, Abbruzzese JL, et al.Borderline resectable pancreatic cancer:definitions, management, and role of preoperative therapy[J].Ann Surg Oncol, 2006, 13:1035-1046. [26] Zaky AM, Wolfgang CL, Weiss MJ, et al.Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT:Different Classification Systems and Their Influence on Treatment Planning[J].Radiographics, 2017, 37:93-112. [27] Zhao WY, Luo M, Sun YW, et al.Computed tomography in diagnosing vascular invasion in pancreatic and periampullary cancers:a systematic review and meta-analysis[J].Hepatobiliary Pancreat Dis Int, 2009, 8:457-464. [28] Zamboni GA, Kruskal JB, Vollmer CM, et al.Pancreatic adenocarcinoma:value of multidetector CT angiography in preoperative evaluation[J].Radiology, 2007, 245:770-778. [29] Fletcher JG, Wiersema MJ, Farrell MA, et al.Pancreatic malignancy:value of arterial, pancreatic, and hepatic phase imaging with multi-detector row CT[J].Radiology, 2003, 229:81-90. [30] Bhosale P, Le O, Balachandran A, et al.Quantitative and Qualitative Comparison of Single-Source Dual-Energy Com-puted Tomography and 120-kVp Computed Tomography for the Assessment of Pancreatic Ductal Adenocarcinoma[J].J Comput Assist Tomogr, 2015, 39:907-913. [31] 中华医学会外科学分会胰腺外科学组, 中国研究型医院学会胰腺疾病专业委员会, 中华医学会数字医学分会, 等.胰头癌三维可视化精准诊治专家共识[J].中华外科杂志, 2017, 55:881-886. [32] DoiR, Kami K, Ito D, et al.Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer[J].World J Surg, 2007, 31:147-154. [33] Tseng DS, van Santvoort HC, Fegrachi S, et al.Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer:a systematic review and meta-analysis[J].Surg Oncol, 2014, 23:229-235. [34] Kauhanen SP, Komar G, Seppanen MP, et al.A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer[J].Ann Surg, 2009, 250:957-963. [35] Roche CJ, Hughes ML, Garvey CJ, et al.CT and pathologic assessment of prospective nodal staging in patients with ductal adenocarcinoma of the head of the pancreas[J].AJR Am J Roentgenol, 2003, 180:475-480. [36] Rong D, Mao Y, Hu W, et al.Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma[J].Eur Radiol, 2018, 28:2781-2789. [37] Huang YQ, Liang CH, He L, et al.Development and Validation of a Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer[J].J Clin Oncol, 2016, 34:2157-2164. [38] 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 multi-detector row CT[J].Radiology, 2011, 260:446-453. [39] Marion-Audibert AM, Vullierme MP, Ronot M, et al.Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT:A Prospective Multicenter Study[J].AJR Am J Roentgenol, 2018, W1-W9. [40] 张文文, 郝珊瑚, 王治国, 等.18F-脱氧葡萄糖PET/CT与增强CT在胰腺癌鉴别诊断中应用价值[J].临床军医杂志, 2017, 45:1035-1038. [41] Lecouvet FE, Van Nieuwenhove S, Jamar F, et al.Whole-Body MR Imaging:The Novel, "Intrinsically Hybrid, " Approach to Metastases, Myeloma, Lymphoma, in Bones and Beyond[J].PET Clin, 2018, 13:505-522. [42] 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, 20:1757-1567. [43] Chang ST, Jeffrey RB, Patel BN, et al.Preoperative Multidetector CT Diagnosis of Extrapancreatic Perineural or Duodenal Invasion Is Associated with Reduced Postoperative Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma:Preliminary Experience and Implications for Patient Care[J].Radiology, 2016, 281:816-825. [44] 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, 4:13-20. [45] Tian H, Mori H, Matsumoto S, et al.Extrapancreatic neural plexus invasion by carcinomas of the pancreatic head region:evaluation using thin-section helical CT[J].Radiat Med, 2007, 25:141-147. [46] Zins M, Matos C, Cassinotto C.Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy[J].Radiology, 2018, 287:374-90. [47] 李亮, 程三房, 乔万海.胰腺癌的多层螺旋CT及MRI影像学诊断分析[J].中国CT和MRI杂志, 2016, 14:4-6. [48] Kim M, Jang KM, Kim JH, et al.Differentiation of mass-forming focal pancreatitis from pancreatic ductal adenocarcinoma:value of characterizing dynamic enhancement patterns on contrast-enhanced MR images by adding signal intensity color mapping[J].Eur Radiol, 2017, 27:1722-1732. [49] Yamashita Y, Kato J, Ueda K, et al.Contrast-Enhanced Endoscopic Ultrasonography for Pancreatic Tumors[J].Biomed Res Int, 2015, 2015:491782. [50] Kamisawa T, Imai M, Yui Chen P, et al.Strategy for differentiating autoimmune pancreatitis from pancreatic cancer[J].Pancreas, 2008, 37:e62-e67. [51] Kamisawa T, Wood LD, Itoi T, et al.Pancreatic cancer[J].Lancet, 2016, 388:73-85. [52] Dai C, Cao Q, Jiang M, et al.Serum Immunoglobulin G4 in Discriminating Autoimmune Pancreatitis From Pancreatic Cancer:A Diagnostic Meta-analysis[J].Pancreas, 2018, 47:280-284. [53] 陈佩钦, 王俭.自身免疫性胰腺炎与胰腺癌影像学鉴别[J].肝胆胰外科杂志, 2012, 24:260-261, 264. [54] Lee TY, Kim MH, Park DH, et al.Utility of 18F-FDG PET/CT for differentiation of autoimmune pancreatitis with atypical pancreatic imaging findings from pancreatic cancer[J].AJR Am J Roentgenol, 2009, 193:343-348. [55] Law JK, Stoita A, Wever W, et al.Endoscopic ultrasound-guided fine needle aspiration improves the pre-operative diagnostic yield of solid-pseudopapillary neoplasm of the pancr-eas:an international multicenter case series (with video)[J].Surg Endosc, 2014, 28:2592-2598. [56] Coakley FV, Hanley-Knutson K, Mongan J, et al.Pancreatic imaging mimics:part 1, imaging mimics of pancreatic adenocarcinoma[J].AJR Am J Roentgenol, 2012, 199:301-308. [57] Jeon SK, Lee JM, Joo I, et al.Nonhypervascular Pancreatic Neuroendocrine Tumors:Differential Diagnosis from Pancr-eatic Ductal Adenocarcinomas at MR Imaging-Retrospective Cross-sectional Study[J].Radiology, 2017, 284:77-87. [58] Yin P, Mao N, Zhao C, et al.Comparison of radiomics machine-learning classifiers and feature selection for differentia-tion of sacral chordoma and sacral giant cell tumour based on 3D computed tomography features[J].Eur Radiol, 2018.doi: 10.1007/s00330-018-5730-6. [59] White RR, Paulson EK, Freed KS, et al.Staging of pancreatic cancer before and after neoadjuvant chemoradiation[J].J Gastrointest Surg, 2001, 5:626-633. [60] 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, 118:5749-5756. [61] Xia BT, Fu B, Wang J, et al.Does radiologic response correlate to pathologic response in patients undergoing neoadjuvant therapy for borderline resectable pancreatic malignancy?[J].J Surg Oncol, 2017, 115:376-383. [62] Choi M, Heilbrun LK, Venkatramanamoorthy R, et al.Using 18F-fluorodeoxyglucose positron emission tomography to moni-tor clinical outcomes in patients treated with neoadjuvant chemo-radiotherapy for locally advanced pancreatic cancer[J].Am J Clin Oncol, 2010, 33:257-261. [63] Park MS, Klotz E, Kim MJ, et al.Perfusion CT:noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy[J].Radiology, 2009, 250:110-117. [64] Kim SH, Lee JM, Hong SH, et al.Locally advanced rectal cancer:added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo- and radiation therapy[J].Radiology, 2009, 253:116-125. [65] Fukukura Y, Takumi K, Kamimura K, et al.Pancreatic adenocarcinoma:variability of diffusion-weighted MR imaging findings[J].Radiology, 2012, 263:732-740. [66] Zuo HD, Zhang XM, Li CJ, et al.CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part Ⅰ):Anatomy, imaging of the extrapancreatic nerve[J].World J Radiol, 2012, 4:36-43.
点击查看大图
计量
- 文章访问数: 576
- HTML全文浏览量: 61
- PDF下载量: 147
- 被引次数: 0