胰岛细胞瘤影像学

术前定位的意义
95%的患者，能够在术中检出 1. 仔细观察 2. 触诊
3. 术中超声
第二次手术后，不能检出的病灶为0.5%。

Rothmund M, Angelini L, Brunt LM, et al. Surgery for benign insulinoma: an international review. World J Surg 1990; 14: 393–399.

Tomoaki Ichikawa, Mark S. Peterson, Michael P. Federle, et al. Islet Cell Tumor of the Pancreas: Biphasic CT versus MR Imaging in Tumor Detection. Radiology 2000; 216:163–171
Maarten Brom, Wim J. G. Oyen, Lieke Joosten. 68Ga-labelled exendin-3, a new agent for the detection of insulinomas with PET. Eur J Nucl Med Mol Imaging (2010) 37:1345– 1355
Rodney H Reznek. CT/MRI of neuroendocrine tumours. Cancer Imaging (2006) 6, S163–S177.
评价良恶性的标准
对周围组织器官的侵犯 大小
淋巴结
远处转移 肿瘤的大小决定良恶性、预后，评价是否有症状无意义
腹部BUS
胰岛细胞瘤的影像学检查方法
王鹤
Pancreatic Endocrine Tumors: Radiologic- Clinicopathologic Correlation. RadioGraphics 2010; 30:1445–1464
胰岛细胞瘤
1. 2.
大小 无症状胰岛细胞瘤 <3cm 有症状胰岛细胞瘤 >5cm 体积 血供 3个10% 1%–2% 10%–15%
EUS

King AD, Ko GT, Yeung VT, et al. Dual phase spiral CT in the detection of small insulinomas of the pancreas. Br J Radiol. 1998;71(841):20-23.

Takuya Hosoki. Dynamic CT of Pancreatic Tumors. AJR 140:959-965, May 1983.
Druce MR, Muthuppalaniappan VM, O'Leary B, et al. Diagnosis and localisation of insulinoma: the value of modern magnetic resonance imaging inconjunction with calcium stimulation catheterisation. Eur J Endocrinol. 2010 May;162(5):971-978.
CT CT
谢 谢！
胃泌素瘤
VIP瘤
转移
体型与周围组织的影响 增强BUS应用不普遍
门脉期显示较清晰
龙学颖，李宜雄，王宪伟，等。胰岛素瘤术前ＣＴ定位诊断的回顾性分析 中南大学学报（医学版）J CentSouth Univ(MedSci), 2009,34(2).
Βιβλιοθήκη Baidu

双期增强CT+内镜超声
HervéGouya, Olivier Vignaux, Joelle AuguiCT, et al. Endoscopic Sonography, and a Combined Protocol for Preoperative Evaluation of Pancreatic Insulinomas. AJR,2003;181:987–992