摘要目的 探讨MDCT三维(3D)融合图像在胰十二指肠切除术前评估中的应用价值.方法 回顾性分析2016年3月至2018年5月南京医科大学附属无锡第二医院行胰十二指肠切除术患者的MDCT影像资料,共37例患者纳入本研究.所有患者术前均行MDCT双期增强扫描.将患者CT检查容积数据导入后处理工作站后,分别作肿瘤、胰腺、门静脉系统、动脉系统及胰胆管3D重建,最后行图像融合处理.2位阅片者通过对3D融合图像进行放大、旋转、拆分以及透明化显示等操作,观察肿瘤及其它与胰胆管及血管变异空间关系,并与手术、病理结果 对比.结果 全部患者的3D融合图像均清晰显示了肿瘤、胰腺、门静脉系统、动脉系统和胰胆管系统.对照术中探查与术后大体病理结果,其肿瘤检出与定位准确率为100％.对照术中探查结果,3D融合图像对腹腔干(CA)、脾动脉(SA)、肝总动脉(CHA)、胃十二指肠动脉(GDA)、肝固有动脉(HA)、肠系膜上动脉(SMA)、肠系膜上静脉(SMV)及门静脉(PV)的显示率及其解剖变异的检出率均为100％;胰十二指肠前上动脉(ASPDA)、胰十二指肠后上动脉(PSPDA)、胰十二指肠下动脉(IPA)及胰背动脉(DPA)的显示率分别为85.7％,82.8％,72.2％和75.8％.结论 应用MDCT 3D融合图像技术,能够“一站式”在胰十二指肠切除术术前对肿瘤进行准确定位,良好地展示术区解剖关系及血管解剖变异.

abstractsObjective To study the role of MDCT with 3D fusion images in the preoperative evaluation of pancreaticoduodenectomy.Methods 37 patients who underwent pancreaticoduodenectomy from March 2016 to May 2018 in the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University were included in this retrospective study.All patients underwent a dual-phase enhanced MDCT before operation.The volume data of enhanced MDCT were transmitted to a dedicated CT post-processing workstation.The 3D images,including the tumor,pancreas,portal vein system,arterial system,pancreatic and biliary tract,were reformatted respectively before the fusion imaging.Two reviewers analyzed the tumor location and its spatial relations with the pancreaticobiliary system,peripancreatic vessels and vascular variations by means of zooming,rotating,splitting and transparent displaying on fusion images.Then,the assessed items were compared to the surgical and pathological findings.Results The 3D fusion images of 37 patients in this study depicted the tumor,pancreas,peripancreatic vessels and pancreatic and biliary tract clearly.Compared with the intraoperative and pathological findings,the accuracy of both tumor detection and localization with the 3D fusion images was 100％.To compare the intraoperative findings,visualization and variation detection of the celiac,splenic,common hepatic,gastroduodenal,hepatic,and superior mesenteric arteries,and the superior mesenteric and portal veins were all 100％.Visualizations of the anterior superior pancreaticoduodenal artery (ASPDA),posterior superior pancreaticoduodenal artery (PSPDA),inferior pancreaticoduodenal artery (IPA) and dorsal pancreatic artery (DPA) were 85.7％,82.8％,72.2％ and 75.8％,respectively.Conclusion The MDCT 3D fusion imaging technology allowed one stop preoperative assessment of pancreaticoduodenectomy,especially in clearly outlining the tumor location and its spatial relations with the surrounding surgical anatomies before surgery.