胃低分化神经内分泌癌与低分化腺癌的CT表现及对照研究  

CT differentiation of poor-differentiated gastric neuroendocrine carcinomas from poor-differentiated gastric adenocarcinomas

作　　者：刘畅[1] 韩冬[1] 张海龙[1] 孙娜娜[1] 张玉东[1] 刘希胜[1] LIU Chang;HAN Dong;ZHANG Hailong;SUN Nana;ZHANG Yudong;LIU Xisheng(Department of Radiology ,the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 ,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《实用放射学杂志》2018年第5期709-713,共5页Journal of Practical Radiology

摘　　要：目的 探讨胃低分化神经内分泌癌（PD-NECs）和胃低分化腺癌（PD-ADCs）的CT表现，并对两者进行比较，以提高诊断准确率。方法 收集经病理证实为胃PD-NECs的29例及胃PD-ADCs的29例患者，回顾性分析其临床资料及CT表现，并采用单因素及多因素分析对两者进行比较。结果 在单因素分析中，胃PD-NECs较胃PD-ADCs病灶最大长径更小（P=0.002），边界更清楚（P〈0.001），病灶表面有完整的黏膜覆盖（P〈0.001）且动脉期病灶与正常胃黏膜的CT值之比更高（P=0.004）。多因素分析显示病灶表面完整的黏膜覆盖（OR=0.028，95%可信区间为0.001~0.863，P=0.041）及动脉期病灶与正常胃黏膜CT值之比（OR=0.015，95%可信区间为0.000~0.495，P=0.019）是影响胃PD-NECs和胃PD-ADCs两者鉴别诊断的独立因素。受试者工作特征曲线（ROC曲线）分析表明，动脉期病灶与正常胃黏膜CT值之比对两者鉴别具有中等价值［曲线下面积（AUC）为0.72］。结论 在CT表现上，胃PD-NECs较胃PD-ADCs病灶边界更清，病灶表面有完整黏膜覆盖的几率更高且动脉期病灶强化更明显。Objective To compare the CT findings of poor-differentiated gastric neuroendocrine carcinomas （PD-NECs） and poor-differentiated gastric adenocarcinomas （PIYADCs） ,and to increase the diagnostic accuracy rate.Methods In this retrospective study that enrolled 29 gastric PD-NECs and 29 gastric PD-ADCs, whose diagnoses were proven pathologically, we assessed their clinical characteristics and CT findings and then used univariate and multivariate analyses for statistical comparisons.Results The univariate analysis revealed that gastric PD-NECs were significantly smaller （P = 0.002）, more often showed well-defined margins （P〈0.001）, and more frequently accompanied with intact overlying mucosa on CT when compared with gastric PD-ADCs （P〈0.001）.In the multivariate analysis, the presence of intact overlying mucosa （OR= 0.028,95% CI ： 0.001-0.863, P =0.041) and tumor-to-mucosa HU ratio on the arterial phase (OR = 0.015,95 % CI ： 0.000-0.495, P = 0.019) were two independent factors affecting the identification of gastric PD-NECs and gastric PD-ADCs.Receiver operating characteristic analysis （ROC） showed that the value of tumor-to-mucosa HU ratio on the arterial phase in differentiating them was moderate （AUC=0.72）.Conclusion Gastric PD-NECs have better-defined margin, more intact overlying mucosa and higher tumor-to-mucosa HU ratio on the arterial phase than gastric PD-ADCs.

关 键 词：胃肿瘤 低分化神经内分泌癌 低分化腺癌 计算机体层成像 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]