胰腺神经内分泌肿瘤多层螺旋CT双期增强扫描特征  

Dual-phase contrast enhancement multi-slice CT in grading pancreatic neuroendocrine tumors

作　　者：周延[1] 刘剑羽[1] 朱翔[2] 

机构地区：[1]北京大学第三医院放射科,100191 [2]北京大学医学部病理学系

出　　处：《中华放射学杂志》2013年第3期225-230,共6页Chinese Journal of Radiology

摘　　要：目的探讨胰腺神经内分泌肿瘤（NET）的临床及双期增强MSCT特点。方法回顾性分析20例胰腺NET的临床表现、双期增强MSCT影像特点及肿瘤强化方式，并分别测量平扫、动脉期与门静脉期病变及周围胰腺组织CT值，计算肿瘤强化绝对值：动脉期肿瘤最高绝对强化程度A1和最低绝对强化程度A2；门静脉期最高绝对强化程度V1和最低绝对强化程度V2。计算肿瘤与正常胰腺增强后密度差别：（1）动脉期最高强化区与正常胰腺cT值差值AP1；（2）最低强化区与胰腺CT值差值AP2；（3）门静脉期最高强化区与胰腺CT值差值VP1；（4）最低强化区与胰腺CT值差值VP2。参照2010年WHO最新分类方法，以手术病理为标准，将肿瘤分为1～3级。应用KruskalWallis非参数检验比较不同级别NET患者的肿瘤直径以及不同分级NET间各参数值的差异，并描述随级别升高上述各值的变化趋势；应用Fisher精确检验比较不同级别NET的临床表现和影像表现问的差异。结果20例胰腺NET患者，共有瘤灶23个，其中WHO1～3级肿瘤分别为13、8和2个。病理分级1级的10例患者中，无内分泌异常和合并内分泌异常者分别为7例和3例；6例无腹痛，4例有腹痛；均无肝转移。病理分级2级的8例中，无内分泌异常和合并内分泌异常者均为4例；5例无腹痛，3例有腹痛；6例无肝转移，2例出现肝转移。病理分级3级的2例患者中，均无内分泌异常，有腹痛者1例，均出现肝转移。不同病理分级的患者间出现内分泌异常和腹痛的差异无统计学意义（χ2值分别为2．238和0．713，P值分别为0．318和1．000）；出现肝转移情况的差异有统计学意义（χ2=9．516，P=0．003）。不同病理级别肿瘤的瘤灶位置、边界清晰与否、是否伴囊变坏死和（或）钙化间差异均无统计学意义。不同级别肿瘤强化程度各参数均表现出随病理级别增高而下降趋势�Objective To evaluate characteristic clinical and imaging findings of pancreatic neuroendocrine tumors （NET） in dual-phase contrast enhancement MSCT. Methods The dual-phase contrast enhancement MSCT images of 23 lesions in 20 patients with histologically confirmed pancreatic NET were studied retrospectively. Their clinical presentations, imaging characters as well as the intensities of lesions and normal pancreas in each phase were measured, and the following indices were calculated. First, the absolute enhancement of lesions, including the increasing of CT value of the maximum enhancement area within a tumor in arterial phase,that was named A1 in short, and that of the minimum enhancement area was labeled as A2. The same ROI measured increasing CT values in portal venous phase was labeled as V1 and V2 respectively. Secondly, the relatively enhancement indices comparing with the normal pancreas in the same patient within the same phase were calculated. This included the differences between the maximum, aswell as the minimum, enhancement areas of tumors and the normal pancreas in arterial phase, which was named as AP1 and AP2 respectively, and those differences in portal venous phase ,which were labeled as VP1 and VP2 respectively. All of the tumors were graded as G1 to G3 according to the WHO classification in 2010. A Kruskal Wallis test were performed to compare differences of tumor diameters and the enhancement indices. The change trend of enhancement indices varying with pathology grading were described. Fisher exact test was used to find differences of clinical and imaging characters. Results Twenty-three lesions in 20 patients included 13 lesions in grade 1 （G1） ,8 in G2 ,and 2 in G3. Among the 10 patients with G1 NET, 7 of them had no endocrine symptoms, while the other 3 had endocrine symptoms. Six of them had no abdominal pain, while 4 of them complained of it. All of the 10 patients with G1 NET had no hepatic metastasis. Among 8 patients with G2 NET,4 of them were with endocrine abnormality, and

关 键 词：胰腺肿瘤 体层摄影术 X线计算机 

分 类 号：R735.9[医药卫生—肿瘤]