胰腺导管内乳头状粘液性肿瘤的影像特征及其良恶性鉴别  

Imaging features of intraductal papillary mucinous neoplasms of the pancreas for predicting the malignant potential

作　　者：文侃 吴磊迪 岑春媛 黄梦庭 杨红丽 悅笑斐 卢玉婷 马桂娜 李欣[1] 韩萍[1] WEN Kan;WU Leidi;CEN Chunyuan;HUANG Mengting;YANG Hongli;YUE Xiaofei;LU Yuting;MA Guina;LI Xin;HAN Ping(Department of Radiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Province Key Laboratory of Molecular Imaging,Wuhan 430022,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院放射科分子影像湖北省重点实验室,湖北武汉430022

出　　处：《医学影像学杂志》2021年第2期269-274,共6页Journal of Medical Imaging

基　　金：国家自然科学基金面上项目(编号:81873895)。

摘　　要：目的分析良、恶性胰腺导管内乳头状粘液性肿瘤(IPMN)的CT和MRI特征,探讨其对于IPMN良恶性的鉴别诊断价值。方法选取经手术病理证实的70例IPMN患者的临床及影像资料。根据病理诊断将70例IPMN分为良性组和恶性组;筛选分析与鉴别IPMN良恶性相关的临床与影像特征,并绘制受试者工作特征曲线(ROC),评估其对良恶性IPMN的鉴别诊断效能,P<0.05为差异有统计学意义。结果70例中,良性组43例,恶性组27例。统计分析显示DWI弥散受限、CA199升高、主胰管径≥10 mm、病灶直径≥3 cm、肿瘤含实性成分、壁结节≥5 mm、肿瘤分型(主胰管型和分支胰管型)在良恶性IPMN中的分布(P<0.05)为差异有统计学意义。ROC分析显示ADC值、主胰管径、病灶直径鉴别良恶性IPMN的AUC分别为0.866、0.716、0.708(P<0.05),最佳界值为2.61×10^(-3) mm^(2)/s、10.5 mm、3.05 cm;弥散受限、CA199升高、实性成分鉴别良恶性IPMN的AUC分别为0.788、0.759、0.650。联合使用上述征象鉴别良恶性IPMN的AUC为0.964(P<0.001),灵敏度为91.7%,特异性为90.9%。结论影像学检查对IPMN的诊断、分型及良恶性鉴别具有重要价值,多征象综合分析可以有效提高诊断效能。Objective To analyse the CT and MR imaging features of pancreatic intraductal papillary mucinous neoplasms(IPMNs)for differentiating benignity from malignancy.Methods Seventy histopathology-proven cases were divided into the benign and malignant groups.The clinical and imaging features related to the differential diagnosis of benign and malignant IPMNs were screened and analysed,and ROC curves were drawn to evaluate their efficacy.Results Of the 70 cases,there were 40 and 26 individuals in the benign and malignant groups,respectively.Statistical analysis showed significant differences between the two groups in the following:dispersion limitation,evaluation of CA199,main pancreatic duct dilatation≥10 mm,cyst diameter≥3 cm,mural nodule≥5 mm,solid components and tumour classification(MD-IPMN and BD-IPMN).ROC curve analysis showed that the AUC of ADC value,main pancreatic duct diameter and lesion diameter for differentiating benign and malignant IPMN were 0.866,0.716 and 0.708 respectively,and the best cut-off value was 2.61×10^(-3) mm^(2)/s,10.5 mm and 3.05 cm.The AUC of dispersion limitation,CA199 and solid components for differentiating benign and malignant IPMN were 0.788,0.759 and 0.650 respectively.Combined with the above signs,the AUC of differential diagnosis of benign and malignant IPMN was 0.964(P<0.001),the sensitivity was 91.7%,and the specificity was 90.9%.Conclusion Imaging examination has important clinical value in the diagnosis,classification and differentiation of benign and malignant IPMNs and combined with the analysis of CT and MR signs can effectively improve the diagnostic efficiency.

关 键 词：胰腺导管内乳头状粘液性肿瘤 体层摄影术 X线计算机 磁共振成像 胰腺 

分 类 号：R736.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]