Malign Pankreas Hastalıklarında Görüntüleme
Özet
Pankreasın malign neoplazileri, %90'ı ekzokrin kökenli olan duktal adenokarsinom ve nadir asiner hücreli karsinom başta olmak üzere heterojen bir gruptan oluşmaktadır. Görüntüleme yöntemleri arasında ultrasonografi (US), bilgisayarlı tomografi (BT), manyetik rezonans görüntüleme (MRG), pozitron emisyon tomografisi (PET) ve endoskopik ultrasonografi (EUS); lezyonların karakterizasyonunda, evrelemede ve tedavi takibinde kritik öneme sahiptir. İlk basamak tanı yöntemi olan US'nin duyarlılığı düşüktür. Çok dedektörlü bilgisayarlı tomografi (MDBT), vasküler tutulumu ve rezektabiliteyi değerlendirmede en etkin yöntemdir. MRG ve MR kolanjiopankreatografi (MRKP), yüksek doku kontrastı sayesinde küçük tümörleri saptamada ve lezyonların pankreatik kanalla ilişkisini göstermede üstündür. EUS, küçük tümörlerin tespitinde ve ince iğne aspirasyon biyopsisi (İİAB) ile histopatolojik tanıda yüksek doğruluk sağlar. FDG-PET/BT ise nüks saptamada ve tedavi yanıtını değerlendirmede MDBT'den daha duyarlıdır. Pankreatik nöroendokrin tümörler, arteriyel fazda hipervasküler karakterleriyle adenokarsinomlardan ayrılır. İntraduktal papiller müsinöz neoplazi (IPMN), seröz ve müsinöz kistik neoplaziler ise farklı malignite potansiyellerine sahip sık kistik lezyonlardır. Cerrahi rezeksiyon kararı, tümörün süperior mezenterik arter, çöliyak arter ve portal ven gibi ana vasküler yapılarla olan temas derecesine göre belirlenmektedir.
Malignant neoplasms of the pancreas represent a heterogeneous group of tumors, with 90% being of exocrine origin, primarily ductal adenocarcinoma and rare acinar cell carcinoma. Imaging modalities, including ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and endoscopic ultrasonography (EUS), play pivotal roles in lesion characterization, staging, and treatment monitoring. While US is the initial diagnostic tool, its sensitivity is limited. Multidetector computed tomography (MDCT) is the most effective modality for evaluating vascular involvement and resectability. MRI and MR cholangiopancreatography (MRCP) excel in detecting small tumors and determining the relationship between lesions and the pancreatic duct due to high soft-tissue resolution. EUS provides exceptional accuracy for identifying tumors under 3 cm and enables histopathological evaluation via fine-needle aspiration biopsy (FNAB). FDG-PET/CT demonstrates superior sensitivity over MDCT in detecting recurrence and assessing treatment response. Pancreatic neuroendocrine tumors are distinguished from adenocarcinomas by their hypervascular nature during the arterial phase. Intraductal papillary mucinous neoplasms (IPMN), serous, and mucinous cystic neoplasms comprise common cystic lesions with distinct malignant potentials. Surgical resectability is strictly determined by the degree of tumor contact with major vascular structures, such as the superior mesenteric artery, celiac axis, and portal vein.
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