多层CT对胰腺神经内分泌肿瘤病理分级的可行性  

CT imaging features of different histological grades of pancreatic neuroendocrine tumors

作　　者：刘黎明 唐艳华[2] 王海屹[2] 王英伟[2] 叶慧义[2] 袁静[3] 

机构地区：[1]天津市宁河区医院放射科,301500 [2]解放军总医院放射科,北京100853 [3]解放军总医院病理科,北京100853

出　　处：《中华放射学杂志》2016年第2期105-109,共5页Chinese Journal of Radiology

摘　　要：目的探讨胰腺神经内分泌肿瘤（pNET）的多层CT表现诊断病理分级的可行性和价值。方法回顾性分析经手术病理证实为pNET，术前均行上腹部CT平扫及双期增强扫描的21例pNET患者的影像资料。重点观察病变位置、数目、最大径，观察有无钙化、囊变坏死、胰管扩张，包膜是否完整，是否有恶性征象等。测量计算平扫CT值、相对密度指数，动脉期CT值、CT差值、增强百分比、增强指数，门静脉期CT值、CT差值、增强百分比、增强指数。依据肿瘤细胞的核分裂数和ki-67指数将病灶进行病理分级，分为G1、G2、G3级。采用Kruskal-Wallis法比较不同病理分级患者间年龄、性别、是否存在内分泌功能、病灶形态特征的差异，采用单因素方差分析（符合正态分布的数据）或Kruskal-Wallis法比较不同病理分级组间CT平扫及增强扫描参数的差异。结果21例pNET患者共检出24个病灶，其中G1级13个、G2级7个、G3级4个。不同病理级别pNET患者的年龄、性别差异无统计学意义（P〉0．05）。G1级病灶中，9个有内分泌功能，G2级病灶中，1个有内分泌功能，差异有统计学意义（χ^2=8．355，P=0.012）。位于胰头、钩突或颈部的G1、G2、G3级病灶分别为11、5、2个，位于体尾部病灶分别为2、2、2个。G1、G2、G3级病灶最大径中位数分别为1．5、2．5、6．7cm，包膜完整的病灶分别为13、4、0个，囊变坏死病灶分别为2、3、3个，钙化病灶分别为0、2、2个，胰胆管扩张病灶分别为0、1、2个，合并恶性征象的病灶分别为0、1、4个。不同病理级别pNET病灶的最大径、包膜完整性、钙化、胰胆管扩张和恶性征象的出现率差异均有统计学意义（P均〈0.05），病灶位置和出现囊变坏死的差异均无统计学意义（P均〉0．05）。不同病理级别pNET病灶具有相似平扫CT值、相对密度指数，对于动脉期CT值、CT差值、增强百�Objective To explore diagnostic value of multi-slice spiral CT imaging features with respect to pancreatic neuroendocrine tumors （pNET） of different histological grades. Methods A retrospective analysis of preoperative abdominal plain CT and dual-phased contrast-enhanced CT was performed in 21 patients （median age, 47 years; 12 males and 9 females） with pathologically proven pNET. age, gender, endocrine function, location and size of lesion, cystic change or necrosis, completeness of capsule, calcification, dilation of pancreatic duct were evaluated.CT attenuation-related parameters （plain CT value, relative density index, and CT value, CT value difference, enhanced percentage and enhancement index on arterial and portal phase） of each tumor were measured or calculated. All tumors were pathologically classified into three histological grades （G1, G2 and G3） based on mitotic count and ki-67 index. Kruskal-Wallis test was performed to compare differences of age, gender, endocrine function,morphological features among different grades. CT attenuation-related parameters were evaluated using Kruskal-Wallis or one-way analysis of variance （ANOVA）. Results Twenty four pNET foci [grade G1 （n= 13）, G2 （n=7） and G3 （n=4）] were seen in the 21 patients. The difference of age, gender among different grades demonstrated no statistical significance （P〉0.05）. Nine lesions of G1 and 1 lesion of G2 demonstrated endocrine function, and the difference of endocrine function among three grades was statistically significant （χ^2=8.355,P=0.012）. For G1, G2 and G3, 11, 5 and 2 lesions were seen in uncinate process, pancreatic head and neck, respectively while 2, 2 and 2 lesions in pancreatic body and tail, respectively. The median maximum diameter of pNET of G1, G2 and G3 was 1.5, 2.5 and 6.7 cm, respectively; For G1, G2 and G3, 13, 4 and 0 lesions demonstrated intact capsule, respectively while 2, 3, and 3 lesions cystic degeneration and necrosis, respectivel; 0, 2 and 2 lesions calcification,r

关 键 词：胰腺肿瘤 神经内分泌肿瘤 体层摄影术 X线计算机 

分 类 号：R735.9[医药卫生—肿瘤] R730.44[医药卫生—临床医学]