直肠神经内分泌肿瘤的影像学分析  

Imaging findings of endocrine tumor of the rectum

作　　者：梁振威[1] 蒋力明[1] 李颖[1] 耿呈云[1] 姜军[1] 叶枫[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院影像诊断科,北京100021

出　　处：《中华肿瘤防治杂志》2015年第11期867-870,884,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：中国胃肠胰神经内分泌肿瘤临床流行病学研究辉瑞公司基金(WS1910269)

摘　　要：目的分析新病理分级下直肠神经内分泌肿瘤（neuroendocrine neoplasm,NEN）的影像学表现,提高对直肠NEN的术前诊断率。方法收集2010-03-01-2014-03-31经手术病理确诊、有完整影像学资料的直肠NEN患者37例,分析直肠NEN的影像学表现及不同级别间影像学表现差异。结果 37例直肠NEN均为无功能性。参照WHO 2010年消化系统肿瘤分类和2010年中国病理学诊断共识,G1级32例,G2级1例,G3级4例,单发多见（33/37）。G1~G2级33例,长径均〈2.0cm（平均1.0cm,G2级1例长径为5cm）,边界清楚,增强均为明显强化;其中30例为黏膜面息肉样或结节隆起型病变,31例黏膜表面光滑,1例出现淋巴结转移,均未见肝转移。G3级4例,病变长径均〉2.0cm（平均6.4cm）,均侵犯肠管1/2周以上或呈环周性生长,侵犯浆膜外或纤维膜外,边界不清楚,黏膜表面不规则,增强扫描明显强化;其中3例出现淋巴结转移,1例出现肝转移。结论增强扫描明显强化是直肠神经内分泌肿瘤的影像特征,低级别（G1、G2级）病灶长径小,形态规则,远处转移少见,而高级别（G3级）病变长径大,侵袭性生长特点明显。OBJECTIVE To improve the preoperative diagnostic accuracy,imaging findings of rectal neuroendocrine neoplasm（NEN）were described and analyzed.METHODS Both plain and enhanced spiral imaging findings in 37 cases with rectal neuroendocrine neoplasm were retrospectively analyzed,with histological or pathological documents.All of the tumors were graded as G1 to G3according to the WHO classification of tumors of the digestive system and pathology consensus of China in 2010.The lesions＇ number,location,shape,size,density,enhancement patterns and other changes on contrast-enhanced images were observed.RESULTS Of the 37 rectal NEN patients,33 patients had single rectal NEN and multiple NEN was detected in 4cases.All of them had no endocrine symptoms.G1 tumors were found in 32 patients,G2in 1patients,G3 in 4patients.Marked enhancement was observed on CT scan.The lesions in NET（neuroendocrine tumor,G1 and G2）appeared as submucol hemispherical polypoid bulge（30/33）,the tumor size was less than 2.0cm in diameter in 33cases（33/33,a mean value of 6.4cm）,which was regular in shape and well defined（33/33）,marked enhancement（33/33）.Lymphadenopathy at peritoneal cavity was founded in 1case（1/33）,metastatic hepatic neuroendocrine carcinoma was not found（0/33）.The lesions in NEC（neuroendocrine carcinoma,G3）were often larger than 2.0cm in diameter（a mean value of 6.4cm）,including mural mass with asymmetric or concentric bowel wall thickening in 4cases（NEC,4/4）,irregular in shape and ill-defined（4/4）,periplasmic space was invaded in 4cases（NEC,4/4）.Lymph nodes metastases were present at 3cases（3/4）and hepatic metastases were present at 1cases（1/4）.CONCLUSIONSRectal NEN is commonly hypervascular.Imaging features correlate to the pathological grade.Well-differentiated NEN tumors（G1-G2）are characterized by a small solid tumor,well defined,with less nodal or distant metastatic disease at presentation.Poorly differentiated endocrine carcinoma（G3）is relatively larger in siz

关 键 词：直肠神经内分泌肿瘤/影像学 病理分级 体层摄影术 X线计算机 核磁共振成像 

分 类 号：R735.37[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2