| Objective:(1) To analyze the Multi-Slice CT(MSCT) finding of the celiac ganglia, so as to provide reference information for the efficience implementation of CT guided neurolytic celiac plexus block(NCPB) and the imaging anatomy of peripancreatic nerve structure. (2)To preliminarily analyze MSCT diagnosis in extrapancreatic neural plexus invasion by pancreatic carcinoma.Methods:(1) To observe the 150 cases of normal adult abdominal MSCT image. The display rate, location, morphologic, size and CT value of the celiac ganglia were recorded and measured, that are used to proceed the related statistical analysis. (2)To review the MSCT data of 16 cases which were confirmed in operation and pathology of pancreatic cancer patients retrospectively. The extrapancreatic neural plexus invasion on MSCT images was defined as coarse reticula and soft tissue in the fat gap between the tumor and the celiac ganglia or vascular. The MSCT findings were compared with that of pathology, and the sensitivity, specificity, accuracy for MSCT diagnosing extrapancreatic neural plexus invasion were calculated.Results:(1) The left celiac ganglia was showed in 141 subjects, while the right celiac ganglia was showed in 124 subjects. There were statistical difference for the display of celiac ganglia between left and right(94% vs 82.7%, P＜0.05). Both sides of the celiac ganglia were identified at the level between the celiac axis and superior mesenteric artery,flat T12-L1 level. The right celiac ganglia was located between the inferior vena cava and the right diaphragm, the left celiac ganglia was found between the left diaphragm and the left adrenal gland. They were strip or multi-nodules,92 cases show ed the strip of left celiac ganglia(65.2%),49 cases were identified as the multi-nodules (34.8%), the strip of right celiac were found in 102 cases(82.3%),the multi-nodules were observed in 22 cases(17.7%), the multi-nodules of left celiac ganglia were greater than the right celiac ganglia(P<0.05). The mean long-axis dimensions of the left and right were (22.8±4.1)mm,(27.6±4.2)mm, respectively, the right celiac ganglia were longer than the left(P<0.001); the mean short-axis dimensions of the left and right were (3.5±0.8)mm, (2.4±0.6)mm, respectively, the left celiac ganglia were larger than the right(P＜0.001). The mean CT value of the left celiac ganglia in unenhanced, arterial and portal venous phase were (24.8±4)HU、(53.9±7)HU、(72.4±10.1)HU. The display rates of left and right celiac ganglia in males were higher than females (P＜0.05). Classification of age:the display rates of left and right celiac ganglia showed statistical difference between the groups of (20-40years,32cases), (40-60years,79cases)and(60-80years,39cases) (P＜0.05); Comparison between each group:the display rates of left and right celiac ganglia in the (20-40years) was lower than (40-60years)(P<0.0125); the display rates of left celiac showed no statistical difference between the group of (20-40years) and (60-80years) (P>0.0125), the display rates of right celiac ganglia in the (20-40years) was slightly lower than (60-80years) (P=0.010<0.0125); the display rates of left and right celiac showed no statistical difference between the group of (40-60years) and (60-80years) (P>0.0125).(2) Sensitivity, specificity, accuracy of the MSCT in the diagnosis of extrapancreatic neural plexus invasion were 85.7%(6/7),55.6%(5/9),68.8%(12/16).Coarse reticular had been found in the fat gap between the tumor and celiac ganglia, and unclear border with celiac ganglia in the 2 cases of 6cases which were confirmed by pathology, and soft tissue had been found in the fat gap between the tumor and vascular in 3 cases, coarse reticular had been found in the fat gap between the tumor and vascular in 1 case.Conclusions:(1) Multi-Slice CT can show the location, size and morphologic feature of celiac ganglia, the display rate of left celiac was higher than right in most cases, because of the right side of the narrow gap around the celiac ganglia structure,someone who were thin may be not clear. The display rate of both sides of celiac ganglia was affected by gender and age, the main cause of the difference was the size and inter organ of fullness had different in disparity gender、age.(2) Coarse reticular and soft tissue appear in the fat gap between the tumor and celiac ganglia or vascular on MSCT images of pancreatic carcinoma were highly suggestive of extrapancreatic neural plexus invasion by pancreatic carcinoma. |
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