胰腺神经内分泌肿瘤超声造影表现与病理对照  

Contrast-enhanced ultrasonography of pancreatic neuroendocrine neoplasms： correlation with pathologicalfindings

作　　者：王延杰[1] 孙利[2] 严昆[1] 范智慧[1] 杨薇[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室超声科,100142 [2]北京大学肿瘤医院病理科,100142

出　　处：《中华超声影像学杂志》2016年第3期207-211,共5页Chinese Journal of Ultrasonography

基　　金：基金项目：首都临床特色应用研究（Z131107002213147）

摘　　要：目的对照分析胰腺神经内分泌肿瘤（pancreaticneuroendocrineneoplasms，pNENs）的超声造影（contrastenhancedultrasonography，CEUS）表现与病理组织学改变，探讨CEUS对pNENs的诊断价值。方法回顾分析16例病理诊断为pNENs的CEUS表现，对照同期获得病理诊断的30例胰腺癌CEUS表现，分析肿瘤的CEUS增强强度及增强模式。所有pNENs病理标本行HE染色，获得间质含量分级、增殖活性Ki-67指数；行CD34免疫组化染色，获得微血管密度（microvasculardensity，MVD）。Spearman秩检验进行相关性分析。结果16例pNENs中，12例（75．0％）呈高及等增强，其中6例（37．5％）为均匀强化，6例（37．50．4）为不均匀强化；4例（25．0％）呈低增强，均为均匀强化。30例胰腺癌，25例（83．3％）呈低增强，5例（16．7％）呈高及等增强；21例（70．0％）呈不均匀增强，9例（30．0％）呈均匀增强。以CEUS等及高增强作为pNENs的诊断标准，诊断敏感性、特异性、阳性预测值、阴性预测值、诊断准确性分别为75．0％、83．3％、70．6％、86．2％80．4％。pNENs增强程度与间质含量呈负相关（r=-0．880，P〈0．001），与MVD呈正相关（r=0．658，P=0．003）。6例不均匀强化pNENs无增强区病理表现为囊性变或坏死。结论CEUS是诊断pNENs无创有效的手段，高及等增强是pNENs典型CEUS表现，不同CEUS表现反映肿瘤组织病理学的改变。Objective To compare the contrast-enhanced ultrasonography （CEUS） manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April, 2012 to February, 2014 were retrospectively observed. The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group. The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry. The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density （MVD） were obtained on CD34 immunochemistry stained slices. Spearman rank test analysis was employed to analyze the correlation. Results Among the 16 cases of pNENs, 12 cases （75.0%） demonstrated hyper- or iso-enhancement, which included 6 cases （37.50% ） showing homogeneous enhancement and 6 cases （37.5%） showing inhomogeneousen hancement, and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas, 25 cases （83.3%） demonstrated hypo-enhaneement and 5 cases （ 16.7 % ） hyper- or iso-enhancement, and 21 cases （70.0% ） demonstrated homogenous enhancement, and 9 cases （30.0 %） inhomogeneous enhancement. Taking hyper- or iso-enhancement on CEUS as the diagnostic criteria, its diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 75.0%, 83.3%, 70.6%, 86.2%, 80.4% respectively. Negative and positive correlation of the enhancement extent of pNENs with the interstitial content （ r = - 0.880, P 〈 0.001） and MVD （ r = 0.658, P = 0.003） were observed, respectively. Sixtumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes. Hyper- or iso-enh

关 键 词：超声造影 胰腺肿瘤 神经内分泌肿瘤 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.9[医药卫生—诊断学]