Выход
Вход
 
E-mail
Пароль
Забыли пароль?
Введите E-mail и жмите тут. Пароль будет выслан на указанный адрес
Войти (LogIn)

 

Если вы первый раз здесь, то зарегистрируйтесь

Регистрация
Полное имя (Ф.И.О.)
E-mail
Телефон
Зарегистрироваться,
на ваш E-mail будет выслан временный пароль

 

Медицинская литература. Новинки


 

 

 

 

 

 
вce журналы << Медицинская визуализация << 2015 год << №5 <<
стр.52
отметить
статью

Аденокарцинома поджелудочной железы: выявление, определение стадии и дифференциальная диагностика

Шима В. В., Кауэлблингер К.
Вы можете загрузить полный текст статьи в формате pdf
Шима Вольфганг - врач, магистр естественных наук, Отделение диагностической и интервенционной радиологии, wolfgang.schima@khgh.at, Вена, Австрия
Кауэлблингер К. - Отделение диагностической и интервенционной радиологии,

Диагностика и лечение аденокарциномы поджелудочной железы сопряжены со значительными трудностями. В большинстве случаев на момент постановки диагноза уже имеются регионарные и отдаленные метастазы, что исключает возможность проведения радикальной операции. Томографические методы визуализации играют важнейшую роль в диагностике, стадировании рака поджелудочной железы и стратификации пациентов на основе полученных данных. Методом выбора при диагностике новообразований поджелудочной железы признана мультиспиральная компьютерная томография (МСКТ) с внутривенным контрастированием, в то время как МРТ с использованием гадолиния, ДВИ и МРХПГ отведена уточняющая роль. Для стадирования опухолей необходимо определить наличие или отсутствие вовлечения сосудов, метастатического поражения печени и лимфатических узлов. В зависимости от этих параметров опухоли подразделяют на полностью резектабельные (clearly resectable), погранично резектабельные (borderline resectable) и нерезектабельные (non-resectable). Для последней группы характерно наличие отдаленных метастазов или вовлечения чревного ствола/верхних брыжеечных артерий. Частично резектабельные опухоли представляют наибольшую трудность как для диагностики, так и для лечения. В таких случаях может быть рекомендовано применение комбинированной терапии. Аденокарциному поджелудочной железы необходимо дифференцировать от ряда образований опухолевой, а также неопухолевой природы. В спорных случаях МСКТ следует дополнить магнитно-резонансной томографией и/или эндоскопическим ультразвуковым исследованием с биопсией.

Ключевые слова:
поджелудочная железа, рак, мультиспиральная компьютерная томография, магнитно-резонансная томография, диагноз, Pancreas, cancer, multidetector computed tomography, magnetic resonance imaging, diagnosis

Литература:
1.Zakharova O.P., Karmazanovsky G.G., Egorov V.I. Pancreatic adenocarcinoma: outstanding problems. World. J. Gastrointest. Surg. 2012; 4: 104-113.
2.Schima W., Ba-Ssalamah A., Kolblinger C. et al. Pancreatic adenocarcinoma. Eur. Radiol. 2007; 17: 638-649.
3.Tummala P., Junaidi O., Agarwal B. Imaging of pancreatic cancer: An overview. J. Gastrointest. Oncol. 2011; 2:168-174.
4.Schima W., Ba-Ssalamah A., Goetzinger P. et al. State-of-the-art magnetic resonance imaging of pancreatic cancer. Top Magn. Reson. Imaging. 2007; 18: 421-429.
5.Kim T., Murakami T., Takahashi S. et al. Pancreatic CT imaging: effects of different injection rates and doses of contrast material. Radiology. 1999; 212: 219-225.
6.Yanaga Y., Awai K., Nakayama Y. et al. Pancreas: patient body weight tailored contrast material injection protocol versus fixed dose protocol at dynamic CT. Radiology. 2007; 245: 475-482.
7.Schueller G., Schima W., Schueller-Weidekamm C. et al. Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology. 2006; 241: 441-448.
8.Fukukura Y., Takumi K., Kamiyama T. et al. Pancreatic adenocarcinoma: a comparison of automatic bolus tracking and empirical scan delay. Abdom. Imaging. 2009; 35: 548-555.
9.Goshima S., Kanematsu M., Kondo H. et al. Pancreas: optimal scan delay for contrast-enhanced multi-detector row CT. Radiology. 2006; 241: 167-174.
10.Jang K.M., Kim S.H., Lee S.J. et al. Added value of diffusion-weighted MR imaging in the diagnosis of ampullary carcinoma. Radiology. 2013; 266: 491-501.
11.Park M.J., Kim Y.K., Choi S.Y. et al. Preoperative detection of small adenocarcinoma: Value of ading diffusion-weighted imaging to conventional MR imaging for improving confidence level. Radiology. 2014; 273: 433-443.
12.Kartalis N., Loizou L., Edsborg N. et al. Optimising diffusion-weighted MR imaging for demonstrating pancreatic cancer: a comparison of respiratory-triggered, free-breathing and breath-hold techniques. Eur. Radiol. 2012; 22: 2186-2192.
13.Koelblinger C., Ba-Ssalamah A., Goetzinger P. et al. Gadobenate dimeglumine-enhanced 3.0-T MR imaging versus multiphasic 64-detector row CT: prospective evaluation in patients suspected of having pancreatic cancer. Radiology. 2011; 259: 757-766.
14.Prokesch R., Chow L.C., Beaulieu C.F. et al. Isoattenuating pancreatic carcinoma at multi-detector row CT: secondary signs. Radiology. 2002; 224: 764-768.
15.Yoon S.H., Lee J.M., Cho J.Y. et al. Small (
16.Kim J.H., Park S.H., Yu E.S. et al. Visually isoattenuating pancreatic adenocarcinoma at dynamic-enhanced CT: frequency, clinical and pathologic characteristics, and diagnosis at imaging examinations. Radiology. 2010; 257: 87-96.
17.Krishna N.B., LaBundy J.L., Saripalli S. et al. Diagnostic value of EUS-FNA in patients suspected of having pancreatic cancer with a focal lesion on CT scan/MRI but without obstructive jaundice. Pancreas. 2009; 38: 625-630.
18.Agarwal B., Krishna N.B., Labundy J.L. et al. EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointest. Endoscopy. 2008; 68: 237-242.
19.Bipat S., Phoa S.S.K.S., van Delden O.M. et al. Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis and determining resec tability of pancreatic carcinoma. J. Comput. Assist. Tomogr. 2005; 29: 438-445.
20.Shrikhande S.V., Barreto S.G., Goel M., Arya S. Multimodality imaging of pancreatic ductal adeno carcinoma: a review of the literature. HPB (Oxford). 2012; 14: 658-668.
21.Park H.S., Lee J.M., Choi H.K. et al. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J. Magn. Reson. Imaging. 2009; 30: 586-595.
22.Li B., Zhang L., Zhang Z.Y. et al. Differentiation of noncalculous periampullary obstruction: comparison of CT with negative-contrast CT cholangiopancreatography versus MRI with MR cholangiopancreatography. Eur. Radiol. 2015; 25: 391-401.
23.Edge S., Byrd D., Compton C., Fritz A., Greene F., Trotti A. (eds.). AJCC Cancer Staging Handbook, 7th ed. New York: Springer, 2010: 285-296.
24.Mollberg N., Rahbari N.N., Koch M. et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann. Surg. 2011; 254: 882-893.
25.Lu D.S.K., Reber H.A., Krasny R.M. et al. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase thin section helical CT. Am. J. Roentgenol. 1997; 168: 1439-1443.
26.Karmazanovsky G.G., Fedorov V., Kubyshkin V., Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom. Imaging. 2005; 30: 488-500.
27.Li H., Zeng M.S., Zhou K.R. et al. Pancreatic adenocarcinoma. The different CT criteria for peripancreatic major arterial and venous invasion. J. Comput. Assist. Tomogr. 2005; 29: 170-175.
28.Kayahara M., Nagakawa T., Futagami F. et al. Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas. Cancer. 1996; 78: 2485-2491.
29.Tian H., Mori H., Matsumoto S. et al. Extrapancreatic nural plexus invasion by carcinoma of the pancreatic head region: evaluation using thin-section helical CT. Radiat. Med. 2007; 25: 141-147.
30.Katz M.H.G., Pisters P.W.T., Lee J.E., B. F.J. Borderline resectable pancreatic cancer: what have we learned and where do we go from here? Ann. Surg. Oncol. 2011; 18: 608-610.
31.Tamm E.P., Balachandran A., Bhosale P.R. et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol. Clin. N. Am. 2012; 50: 407-428.
32.Al-Hawary M.M., Francis I.R., Chari S.T. et al. Pancreatic ductal adenocarcinoma radiology reporting template: Consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014; 270: 248-260.
33.Lowenfels A.B., Maisonneuve P.M., Cavallini G. et al. Pancreatitis and the risk of pancreatic cancer. New. Engl. J. Med. 1993; 328: 1435-1437.
34.Ichikawa T., Sou H., Araki T. et al. Duct-penetrating sign at MRCP: usefulness for differentiating inflammatory pancreatic mass from pancreatic carcinomas. Radiology. 2001; 221: 107-116.
35.Shimosegawa T., Chari S.T., Frulloni L. et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the International Association of Pancreatology. Pancreatology. 2011; 40: 352-358.
36.Isserow J.A., Siegelman E.S., Mammone J.M. Focal fatty infiltration of the pancreas: MR characterization with chemical shift imaging. Am. J. Roentgenol. 1999; 173: 1263-1265.
37.Katz D.S., Hines J., Math K.R. et al. Using CT to reveal fatcontaining abnormalities of the pancreas. Am. J. Roentgenol. 1999; 172: 393-396.
38.Nikolaidis P., Hammond N.A., Day K. et al. Imaging features of benign and malignant ampullary and perimapullary lesions. Radiographics. 2014; 34: 624-641.
39.Merkle E.M., Boaz T., Kolokythas O. et al. Metastases to the pancreas. Br. J. Radiol. 1998; 71: 1208-1214
40.Ng C.S., Loyer E.M., Iyer R.B. et al. Metastases to the pancreas from renal cell carcinoma: findings on threephase contrast-enhanced helical CT. Am. J. Roentgenol. 1999; 172: 1555-1559.

Pancreatic Adenocarcinoma: Detection, Staging and Differential Diagnosis

Schima W., Koelblmger C.

Pancreatic adenocarcinoma is one of the most challenging tumors to diagnose and to treat. Most patients present with advanced disease that obviates any attempt for curative surgery. Cross-sectional imaging has gained a vital role in the detection of pancreatic cancer and in the stratification of patients according to their tumor stage. Contrastenhanced MDCT is the main pillar in the diagnosis of pancreatic cancer, whereas MRI including MRCP, dynamic gadolinium-enhanced sequences and DWI has an established role as problem-solving tool. For tumor staging, the presence or absence of vascular infiltration, liver and lymph node metastases has to determined. According to their status, tumors can be categorized as clearly resectable, borderline resectable, and nonresectable (with distant metastases or infiltration into celiac trunk or superior mesenteric artery). It is the most difficult task for radiologists and surgeons alike to deal with the group of patients deemed borderline resectable. These patients may profit from a multidisciplinary therapy approach. A variety of neoplastic and non-neoplastic conditions may imitate the appearance of pancreatic adenocarcinoma. Radiologists should be aware of the imaging findings. In equivocal cases multimodality imaging including biopsy may be sought to make a confident alternative diagnosis.

Keywords:
поджелудочная железа, рак, мультиспиральная компьютерная томография, магнитно-резонансная томография, диагноз, Pancreas, cancer, multidetector computed tomography, magnetic resonance imaging, diagnosis

ООО Издательский дом ВИДАР-М, 2016