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КТ-перфузия при опухолях поджелудочной железы

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Цель исследования: провести анализ литературных данных по использованию КТ-перфузии при опухолях поджелудочной железы, сравнить их с результатами собственных исследований и проанализировать полученные данные. Материал и методы. В поисковой системе “pub med” по ключевым словам “CT perfusion of pancreatic tumors” найдено 64 статьи. За период с января 2014 г. по январь 2015 г в Институте хирургии им. А.В. Вишневского выполнено 19 КТ-перфузионных исследований при кистозных и солидных опухолях поджелудочной железы с использованием низкодозового протокола исследования (80 кВ, 100-200 мАс). Постпроцессорная обработка выполнена с помощью модели максимального наклона и кривых плотность/время. Результаты. Показатели КТ-перфузии: для здоровой паренхимы - скорость кровотока (BF-blood flow) - 69,7 мл/100 г/мин, объем кровотока (BV-blood volume) - 25,6 мл/100 г. При протоковой аденокарциноме поджелудочной железы - BF - 15 мл/100 г/мин, BV - 3 мл/100 г. При нейроэндокринных опухолях - BF-202 мл/100 г/мин, BV - 24 мл/100 г. При микрокистозных цистаденомах - BF-56 мл/100 г/мин, BV-30 мл/100 г. Показатель TTP (time to peak) для здоровой железы составил 12 с, при аденокарциноме и кистозных опухолях этот показатель значительно повышается, при нейроэндокринных (гиперваскулярных) опухолях, наоборот, TTP снижается до 4-8 с. Заключение. КТ-перфузия может использоваться в дифференциальной диагностике опухолей поджелудочной железы, однако отсутствие единого протокола сканирования и множество математических моделей расчета перфузии не позволяют выделить стандартизированные критерии для той или иной опухоли. Перфузионные параметры остаются ориентировочными данными. Поэтому необходимо ее использование более широким кругом исследователей с участием большой когорты пациентов.

Ключевые слова:
КТ-перфузия, опухоли поджелудочной железы, метод наклонов, CT perfusion, tumors of the pancreas, maximum slope

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CT Perfusion of Pancreatic Tumors

Purpose. To analyze published data concerning the usage of CT perfusion in pancreatic tumors and to compare them with the results of our own research. Materials and methods. 64 articles were found in the well-known database PubMed by keyword “CT perfusion of pancreatic tumors”. From January 2014 to January 2015 at the A.V. Vishnevsky Institute of Surgery 19 patients with cystic and solid tumors of the pancreas underwent CT-perfusion study using a low-dose protocol (80 kV. 100-200 mAs). Post-processing techniques were performed by the model of maximum slope and the curves density/time. Results. CT-perfusion characteristics of the healthy pancreatic parenchyma were - blood flow (BF) - 69.7 ml/100g/min, the blood volume (BV) - 25.6 ml/100 g. For pancreatic cancer (ductal adenocarcinoma) - BF - 15 ml/100g/min, BV - 3 ml/100 g. For neuroendocrine tumors - BF - 202 ml/100g/min, BV - 24 ml/100 g. For microcystic adenomas BF - 56 ml/100g/min, BV - 30 ml/100 g. Time to peak (TTP) for the healthy pancreatic parenchyma was 12 sec. In case of pancreatic cancer and cystic tumors this parameter significantly increases. And in case of neuroendocrine (hypervascular) tumors it conversely decreases (TTP is reduced to 4-8 seconds). Conclusions. CT perfusion can be used for the differential diagnosis of pancreatic tumors, however, the lack of a single protocol scanning and many mathematical models of calculation do not allow to distinguish standardized criteria. Perfusion settings remain approximate data. That’s why it is necessary to use CT perfusion in a large cohort of patients with larger number of investigators.

Keywords:
КТ-перфузия, опухоли поджелудочной железы, метод наклонов, CT perfusion, tumors of the pancreas, maximum slope