CT鉴别诊断胃肠胰神经内分泌瘤与伴神经内分泌分化腺癌肝转移  

CT in differential diagnosis of hepatic metastases of gastro-enteropancreatic neuroendocrine tumours from adenocarcinomas with neuroendocrine differentiation

作　　者：崔湧[1] 刘玉良[1] 李洁[2] 陆明[2] 汪宁[1] 陈颖[1] 李忠武[3] 沈琳[2] 唐磊[1] 孙应实[1] CUI Yong LIUYuliang LI Jie LUMing WANG Ning CHEN Ying LI Zhongwu SHEN Lin TANG Lei SUN Yingshi(Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research Department of Gastrointestinal Oncology Department of Pathology, Peking University Cancer Hospital ＆ Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所医学影像科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所消化肿瘤内科,北京100142 [3]北京大学肿瘤医院暨北京市肿瘤防治研究所病理科,北京100142

出　　处：《中国医学影像技术》2016年第12期1890-1894,共5页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(61520106004);北京市留学人员科技活动择优资助优秀类项目(京人社调发[2015]6号)

摘　　要：目的 探讨CT鉴别诊断胃肠胰神经内分泌瘤（NETs）肝转移与伴神经内分泌分化腺癌[NED（＋）ADCs]肝转移的价值。方法 收集经手术或活检病理证实的胃肠胰NETs肝转移患者23例（NETs组）及NED（＋）ADCs肝转移患者17例[NED（＋）ADCs组]。对两组CT征象（肝转移灶数目、大小、分布、形态、肝动脉期强化范围、肝动脉期强化程度、增强类型、腹腔积液及淋巴结肿大）的差异进行分析。采用Logistic回归分析确定鉴别诊断的独立影响因素,并计算其敏感度、特异度、阳性预测值、阴性预测值和准确率。结果NETs组肝转移整体强化比例高于NED（＋）ADCs组[56.52%（13/23）vs 5.88%（1/17）,χ2=11.02,P〈0.01]。NETs组肝转移伴淋巴结肿大比例低于NED（＋）ADCs组[30.43%（7/23）vs 64.71%（11/17）,χ2=4.64,P=0.03]。Logistic回归分析结果显示,肝动脉期强化范围是具有鉴别价值的征象（P=0.01）,其诊断敏感度、特异度、阳性预测值、阴性预测值和准确率分别为94.12%（16/17）、56.52%（13/23）、61.54%（16/26）、92.86%（13/14）、72.50%（29/40）。结论 增强CT可为NETs与NED（＋）ADCs肝转移的鉴别诊断提供有价值的参考信息。Objective To evaluate the diagnostic value of CT in hepatic metastases between gastro-entero-pancreatic neuroendocrine tumours （NETs） and adenoearcinomas with neuroendocrine differentiation （NED [＋] ADCs）. Methods Totally 23 hepatic metastases patients of NETs （NETs group） and 17 hepatic metastases patients of NED （＋） ADCs （NED [＋] ADCs group） were enrolled. All the primary tumors were confirmed by pathology. CT features （lesion number, size, distribution, shape, enhancement area in the hepatic artery phase, enhancement degree in the hepatic artery phase, dynamic enhancement pattern, lymphadenopathy and ascites） were compared between the two groups. Independent factor for differ- entiating were evaluated with Logistic regression model. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Results More hepatic metastases of NETs group showed overall enhance- ment comparing with hepatic metastases of NED （＋） ADCs group （56.52% [13/23] vs 5.88% [1/17], Z2 = 11.02, P〈0.01 ）. Lymphadenopathy were more frequently identified in cases of NED （＋） ADCs group than in NETs group （64.71 [11/17] vs 30.43% [7/23], χ2 =4.64, P=0.03）. Enhancement area in the hepatic artery phase was found as an independent factor by Logistic regression （P=0.01）, and the sensitivity, specificity, positive predictive value, negative predictive value was 94.12% （16/17）, 56.52% （13/23）, 61.54% （16/26）, 92.86% （13/14）, 72.50% （29/40）. Conclusion The enhancement area and lymphadenopathy have significant differences between hepatic metastases of NETs and NED （＋） ADCs. Enhanced CT features are helpful in differential diagnosis.

关 键 词：神经内分泌瘤 腺癌 肿瘤转移 体层摄影术 X线计算机 

分 类 号：R735[医药卫生—肿瘤] R814.42[医药卫生—临床医学]