不同病理分级的胰腺神经内分泌肿瘤的MRI征象对比分析及“主胰管绕道征”的诊断价值探讨  

Comparative analysis of MRI signs of different grade pNEN and diagnostic value of "the bypass sign of main pancreatic duct"

作　　者：田序伟[1] 马爱琳[1] 艾克拜尔·吐鲁洪 王禄马[1] 阿布都克尤木·阿不力孜 戴国朝[1] Tian Xuwei;Ma Ailin;Ekbair·Tuluhong;Wang Luma;Abdulkiyom·Abduliz;Dai Guochao(The First People's Hospital of Kashi District,Xinjiang Kashi 844000,China.)

机构地区：[1]新疆喀什地区第一人民医院

出　　处：《现代肿瘤医学》2020年第2期305-310,共6页Journal of Modern Oncology

摘　　要：目的:对比分析G 1、G 2级胰腺神经内分泌肿瘤(pNEN)的MRI征象,探讨“主胰管绕道征”的诊断价值。方法:收集32例pNEN患者的临床资料,以术后病理学检查为金标准,定量分析G 1、G 2级临床指标及影像学指标的差异,并着重分析pNEN与主胰管的关系。结果:32例患者中,病理分级G 1、G 2、G 3级的患者分别有12例、16例、4例,分别以胰尾、胰头、胰颈为主要发生部位。与G 1级神经内分泌瘤(NET)相比,G 2级NET肿瘤直径显著增大,不规则形态的病灶增多,边缘模糊,生物学行为出现明显恶性倾向,主胰管扩张、胰腺外侵犯及淋巴结/肝转移的发生率升高。G 1级NET的MRI平扫信号均质程度高于G 2级(P<0.05),但二者在增强MRI扫描的各个期象信号强度均无明显差异(P>0.05)。28例NET患者中,22例(78.6%)出现主胰管绕道征;神经内分泌癌(NEC)患者无一例出现此征象。术前,28例NET的诊断准确率为78.6%(22/28),存在6例误诊,其中,3例误诊为胰腺癌,2例误诊为囊腺瘤(癌),1例误诊为胰腺假性囊肿。在原MRI诊断依据的基础上纳入“主胰管绕道征”,诊断准确率提高至89.3%(25/28),但仍存在3例误诊,其中2例误诊为囊腺瘤(癌),1例误诊为胰腺假性囊肿,排除了胰腺癌的误诊。结论:MRI对鉴别诊断良恶性pNEN有较高的准确性,但对部分G 1与G 2级NET仍存在一定的误诊率,主胰管绕道征可帮助减少出现胰腺癌误诊。Objective:To compare and analyze the MRI features of grade G 1 and G 2 pNEN,and to explore the diagnostic value of the bypass sign of main pancreatic duct.Methods:The clinical data of 32 patients with pNEN were retrospectively analyzed,and the difference of clinical indicators between G 1 and G 2 was quantitatively analyzed.Results:Among the 32 patients,there were 12 cases in G 1,16 cases in G 2 and 4 cases in G 3,and the main sites were tail of pancreas,head of pancreas and neck of pancreas.Compared with G 1 grade,G 2 grade tumors had significantly larger diameter,more irregular shape lesions,blurred margins and obvious malignant tendency in biological behavior.The level of MRI plain scan signal homogenization of G 1 NET was higher than that of G 2(P<0.05),but there was no significant difference in signal intensity between the two phases of the enhanced MRI scan(P>0.05).Among 28 patients with NET,22(78.6%)had the"the bypass sign of the main pancreatic duct",and none of the NEC patients had this sign.Before operation,the accurate diagnostic rate of NET in 28 cases was 78.6%(22/28),and 6 cases were misdiagnosed."The bypass sign of main pancreatic duct"was included on the basis of the original MRI diagnosis.The accurate diagnosis rate was increased to 89.3%(25/28),but there were still 3 cases of misdiagnosis.Conclusion:MRI has a high accuracy in the differential diagnosis of benign and malignant pNEN,but there is a certain rate of misdiagnosis for partial G 1 and G 2 NET.The main duct bypass sign can help to reduce the misdiagnosis of pancreatic cancer.

关 键 词：胰腺 神经内分泌肿瘤 胰腺癌 磁共振成像 鉴别诊断 

分 类 号：R735.9[医药卫生—肿瘤]