| Objective: To study the value of MSCT angiography (MSCTA) in the pre-operative quantitative assessment of vascular involvement in pancreatic carcinoma. Methods: 51 patients with clinic suspected pancreatic carcinoma were included. The patients were performed plan scans first (Lightspeed 16, GE, USA), and the slices thickness was 10mm. All patients drank 500ml water before the exam. Two-phase spiral CT was performed within one breathhold each. peripheral venous method were used, contrast medium (300 mg I/ml, 80ml) were injected into elbow veins at the speed of 3ml/s.After bolus injection of contrast medium, scanning was performed in the arterial and venous phase, the delay time was 25s and 50s. All the source images were reconstructed to 1.25mm. The pancreatic carcinoma analyses were reformatted by volume rendering (VR) technique, MIP technique, CT angiography (CTA) and multiplanar volume reconstruction (MPVR) technique. Combined the sources and the thin reconstructed images, and the locations and causes of pancreatic carcinoma were shown clearly. Compared the CT scans results with operations and pathological sections, to evaluate the diagnosis value of 16-slices spiral computed tomography scans during pancreatic carcinoma.Results: In 51 pancreatic carcinoma patients, 42 of them were taken operation, 252 vessels were evaluated, and 76 of them were invaded by carcinoma. Celiac trunks were invaded in 9 patients, the sensitivity is 88.9% and the specificity is 90.6%. Superior mesenteric arteries were invaded in 13 patients, the sensitivity is 92.3% and the specificity is 89.2%. Hepatic arteries were invaded in 8 patients, the sensitivity is 75% and the specificity is 93.9%. Portal veins were invaded in 16 patients, the sensitivity is 93.3% and the specificity is 92.6%. Inferior vena cavas were invaded in7 patients, the sensitivity is 71.7% and the specificity is 97.1%. Superior mesenteric veins were invaded in 23 patients, the sensitivity is 82.6% and the specificity is 94.7%. On the fields of vessel-invaded length evaluatied, only 3 vessels of superior mesenteric artery's length were unmatched, and only one or two vessels were unmatched in others by MSCT. When the length between invaded vessel and vessel branches were measured, only one or two patients' MSCT results were not coincidence with surgery result on all arteries.Conclusion: MSCT could delineate the vascular involvement of pancreatic carcinoma with high accuracy, measure the vessel invade correctly and provided valuable information in the preoperative assessment of pancreatic carcinoma.Objective: To evaluate the technique and application value of multi-slices row perfusion for mild acute pancreatitis (MAP).Methods: 53 patients were divided into two groups of were examined by MSCT perfusing. The control group including 30 patients who had not pancreastic diseases (male 23, female 7, ages varies from 37-75, average 51.6) was examined by MSCT. The examination group including 23 pancreastitis patients, perfusion CT of mild acute pancreatitis was performed with 16-section multi-slices row CT. The contrast medium was given at the flow rate of 3.5ml/s from forearm superficial vein. Total dose is 50ml. After perfusion CT scans, the routine parenchymal phase CT scans were performed. All the patients were confirmed by clinic and were divided to grade A or B by CT scans. We obtained two contiguous 10mm slices through the lesion using continuous scanning at 120KVp and 60mA. Data were transferred to ADW4.0 workstation and analyzed using perfusion 2 software. 30 patients with no pancreatic disorders served as controls. Contrast medium-enhanced dynamic CT was performed, and the data were analyzed by using commercial software to calculate tissue blood flow (BF), blood volume (BV), mean transit time (MTT), and vascular permeability-surface (PS) area product. Perfusion parameters of normal pancreas and the mild acute pancreatitis tissues were compared.Results: In all the 23 cases of mild acute pancreatitis tissues, the average BF value was 4751.5±2239.9 ml·min-1?kg-1, BV value was 421.9 ± 215.9 ml ·kg-1,PS value was 439.7±262.3 ml ? min-1 ? kg-1. In the grade A pancreatitis, the average BF value was 6532.2 + 1867.3 ml -min-1?kg-1, BV value was 569.2 ± 223.2 ml?kg-1,PS value was 642.7 ± 227.0 ml ? min-1 ? kg-1 and MTT value was 3.93 ± 1.56s. In the grade B pancreatitis, the average BF value was 3119.3 + 887.5 ml?min-1 ?kg-1, BV value was 286.8±79.3 ml ? kg-1,PS value was 253.6 ± 108.2 ml ? min-1 ? kg-1 and MTT valuewas 6.27±2.54 s. The mild acute pancreatitis tissues showed higher perfusion valuescompared with those of normal pancreas altogether. And the patients who belonged tograde A showed much more higher perfusion values. The grade B patients' pancreatictissues showed lower or equal perfusion values compared with those of normalpancreas.Conclusion: CT perfusion technique can be used to help identify patients with mildacute pancreatitis. This method is worth spreading.Objective: To evaluate the technique and application value of 16 slices spiral-CT perfusion for normal and tumorous pancreas.Methods: 46 patients were divided into two groups of were examined by MSCT perfusing. The control group including 30 patients who had not pancreastic diseases (male 23, female 7 ages varies from 35-75, average 51.6) was examined by MSCT The examination group including 26 pancreatic carcinoma patients and was comformed by surgery (male 19, female 7 ages varies from 36-69, average 48.9). At first routine plain CT scan were performed to localize central slices of tumors, CT perfusion imaging were performed later using a multislice scanner. We obtained two contiguous 10mm slices through the lesion using continuous scanning at 120KVp and 60mA. 50ml iodinated contrast medium was infused via an arm vein at 3.5ml/s. Data were transferred to ADW4.0 workstation and analyzed using perfusion 2 software. Regions of interest (ROI) were drawn in the part of the lesions and the region of normal adjacent to pancreatic tumor, and the data were analyzed by using commercial software to calculate tissue blood flow (BF), blood volume (BV), mean transit time (MTT), and vascular permeability-surface (PS) area product. Perfusion parameters of normal pancreas, tumors tissues and the pancreatic tissues near tumors were compared.Results: There were big individual differences exist in the CT perfusion results. Pancreatic cancer showed higher PS and lower BV and BF compared with those of normal patients' pancreas (PS, t=5.85, BV, t=4.45, BF, t=5.40, P＜0.01, MTT, t=0.96, P>0.05). There were no significant differences in baseline BF, BV, PS and MTT values between normal pancreas and pancreatic tissues near tumors (BF, t=1.50,BV, t=0.97, MTT, t=1.14, PS, t=1.04, P>0.05). Compare with the normal pancreas, statistical results (pair t test) show the pancreatic tissues near tumors CT perfusionwere more significant (BF, t=5.02,BV, t=4.31, MTT, t=0.20, PS, t=6.16, P<0.01). Conclusion: CT perfusion imaging can be used to identify patients with pancreatic carcinomas. For big individual differences exist in the CT perfusion results, the changes in same patient of the different parts were more significant.Objective: To study the correlation between MSCT features and expressions of vascular endothelial growth factor (VEGF), CD34 and HIF-1α in different kinds of pancreatic carcinoma.Methods: The examination group including 26 pancreastic carcinoma patients and was comformed by surgery. At first routine plain CT scan were performed to localize central slices of tumors, CT perfusion imaging were performed later using a multislice scanner. We obtained two contiguous 10mm slices through the lesion using continuous scanning at 120KVp and 60mA. 50ml iodinated contrast medium was infused via an arm vein at 3.5ml/s. Data were transferred to ADW4.0 workstation and analyzed using perfusion 2 software. Regions of interest (ROI) were drawn in the part of the lesions and the region of normal adjacent to tumor, and the data were analyzed by using commercial software to calculate tissue blood flow (BF), blood volume (BV), mean transit time (MTT), and vascular permeability-surface (PS) area product. Expressions of VEGF and HIF1-α in pancreastic carcinoma were examined by immunohistochemical techniques of streptavidin-biotin-peroxidase (SP). The vascular development was measured by MVD that was immunostained with CD34 antigen monoclonal antibody.Results: (1) All 26 patients with pancreatic carcinoma were confirmed by surgery and pathology. 26 cases with pancreatic cancer included 12 cases of poorly differentiated adenocarcinomas, 6 cases of moderately differentiated adenocarcinomas and 8 cases of well-differentiated adenocarcinomas. (2) Poorly differentiated adenocarcinomas show lower CT perfusion value, and well-differentiated adenocarcinomas show higher value (BF: t=6.88,6.79 和 13.19, P＜0.01). The t test between poorly differentiated adenocarcinomas and well-differentiated adenocarcinomas of BV was 3.78 (P<0.01). There were no differences between all kinds of adenocarcinomas in MTT (t=1.17, t=0.89, t=0.16, P>0.05). Poorly differentiated adenocarcinomas show higher PS value,and well-differentiated adenocarcinomas show lower PS value.(3) The MVD, VEGF and HIF-1α value of poorly differentiated adenocarcinomas were 53.6±12.0,. 72.3± 17.3 and 64.4±16.4, much higher than well-differentiated adenocarcinomas (the value were 35.1± 12.8,49.3 ±16.1 and 40.6 ±13.6)(P<0.01). (4) In pancreatic cancer, the mean BF, BV had a significant inverse correlative with the value of MVD and the expressions of VEGF and HIF-1α (P<0.01=, and the MTT has no correlative. the mean PS had a significant postive correlative with the value of MVD and the expressions of VEGF and HIF-1α (p< 0.01 =.Conclusion: (1) The features of MSCT could reflect the histopathology of pancreatic cancer. (2) The pathologic differentiated were closely correlated with MVD and expressions of VEGF and HIF-1α in pancreatic cancer, which could be a noninvasive method in evaluating the biological behavior and malignance, and predicting aggressiveness and metastasis. (3) MSCT perfusion imaging is a functional imaging technique that is capable of quantitative assessment to tumor angiogenesis, and blood perfusion and vascular permeability and it also can provide information of incremental benefit in diagnosis RCC. There is some value of MSCT perfusion imaging in differentiate diagnosis of the pancreatic cancer.
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