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Аденокарцинома поджелудочной железы: выявление, определение стадии и дифференциальная диагностика

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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

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Pancreatic Adenocarcinoma: Detection, Staging and Differential Diagnosis

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