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影像学检查在胰腺导管腺癌临床诊疗路径中的作用及价值

何铭 薛华丹 金征宇 赵玉沛

何铭, 薛华丹, 金征宇, 赵玉沛. 影像学检查在胰腺导管腺癌临床诊疗路径中的作用及价值[J]. 协和医学杂志, 2019, 10(1): 11-18. doi: 10.3969/j.issn.1674-9081.2019.01.003
引用本文: 何铭, 薛华丹, 金征宇, 赵玉沛. 影像学检查在胰腺导管腺癌临床诊疗路径中的作用及价值[J]. 协和医学杂志, 2019, 10(1): 11-18. doi: 10.3969/j.issn.1674-9081.2019.01.003
Ming HE, Hua-dan XUE, Zheng-yu JIN, Yu-pei ZHAO. State-of-the-art Imaging in the Diagnosis and Treatment of Pancreatic Ductal Carcinoma: Current Role and Value[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(1): 11-18. doi: 10.3969/j.issn.1674-9081.2019.01.003
Citation: Ming HE, Hua-dan XUE, Zheng-yu JIN, Yu-pei ZHAO. State-of-the-art Imaging in the Diagnosis and Treatment of Pancreatic Ductal Carcinoma: Current Role and Value[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(1): 11-18. doi: 10.3969/j.issn.1674-9081.2019.01.003

影像学检查在胰腺导管腺癌临床诊疗路径中的作用及价值

doi: 10.3969/j.issn.1674-9081.2019.01.003
基金项目: 

国家自然科学基金面上项目 81871512

详细信息
    通讯作者:

    赵玉沛  E-mail:Zhao8028@263.net

  • 中图分类号: R445;R735.9

State-of-the-art Imaging in the Diagnosis and Treatment of Pancreatic Ductal Carcinoma: Current Role and Value

More Information
  • 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。
    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.
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  • 收稿日期:  2018-10-22
  • 刊出日期:  2020-02-01

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