动态增强MDCT术前鉴别胰腺神经内分泌肿瘤G1/2与G3级的临床价值  

Pancreatic Neuroendocrine Tumors at Dynamic Enhanced Multi-Detector Computed Tomography:Comparison Between Grade 3 and Grade 1/2 Tumors Preoperatively

作　　者：吴菊艺 罗敏[1] WU Juyi;LUO Min(Provincial Clinical Medical College of Fujian Medical University,Department of Radiology,Fujian Provincial Hospital,Fuzhou,Fujian Province 350001,P.R.China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院放射科,福州350001

出　　处：《临床放射学杂志》2021年第6期1131-1135,共5页Journal of Clinical Radiology

摘　　要：目的探讨动态增强MDCT术前鉴别G1/2与G3级胰腺神经内分泌肿瘤(pNET)的临床价值。方法回顾性分析29例手术病理证实为pNET患者的临床资料及动态增强MDCT表现,根据2017年WHO消化道神经内分泌肿瘤分类将29例肿瘤分为G1/2和G3级两组,比较G1/2与G3级两组之间的形态学特征、肿瘤外侵征象和增强扫描各期的差异。结果29例pNET病例中一共发现29个病灶,G1/2级24例(82.8%),G3级5例(17.2%)。静脉期相对强化指数(<0.9)、淋巴结肿大和远处转移对G1/2和G3级两组肿瘤鉴别诊断价值最高(敏感性和特异性均分别为80.0%、91.7%,Odd sratio:44.0);其次是胰胆管扩张、胰周侵犯、延迟期相对强化指数(<0.9)、囊变坏死、动脉期相对强化指数(<1.1)、肿瘤最大直径(>35 mm)和边界不清。当以上10项阳性表现出现2个及以上时,诊断G3级敏感性和特异性分别为100%和83.3%;当出现3个及以上时,诊断G3级pNET敏感性和特异性分别高达100%和95.8%。结论动态增强MDCT可用于术前鉴别G1/2与G3级pNET,具有较高的准确性,有利于指导临床选择。Objective To identify the dynamic enhanced Multi-Detector Computed Tomography(MDCT)features in differentiating pancreatic neuroendocrine tumors(pNET)grade 1/2 and grade 3 preoperatively.Methods A total of 29 patients with postoperative histopathologically proven pNET and who underwent pretreatment dynamic enhanced MDCT were retrospectively analyzed.According to the WHO 2017 pathological classification,all tumors were divided into G1/2 and G3 two subgroups.The morphological features,extrapancreatic invasion and performance on dynamic enhanced MDCT were evaluated.Results Pathology analysis identified 29 lesions in 29 patients.24 lesions(82.8%)were grade 1/2 and 5(17.2%)were grade 3.Portal enhancement ratio(<0.9),lymphadenopathy and distant metastasis showed high sensitivity and specificity 80.0%and 91.7%,respectively in differentiating grade 3 from grade 1/2,it showed the highest Odd sratio(44.0),followed by pancreaticobiliary duct dilation,peripancreatic invasion,delayed enhancement ratio(<0.9),cystic change or necrosis,arterial enhancement ratio(<1.1),tumors maximum size(>35 mm),and unclear boundary.When at least two of these ten criteria were used in combination,the sensitivity and specificity for diagnosing grade 3 were 100%and 83.3%,respectively.When at least three of these ten criteria were used in combination,the sensitivity and specificity for diagnosing grade 3 were 100%and 95.8%,respectively.Conclusion Dynamic enhanced MDCT findings can be used to differentiat grade 3 pNET from grade 1/2 pNET preoperatively,with a high diagnostic accuracy.

关 键 词：胰腺神经内分泌肿瘤 多层螺旋CT 

分 类 号：R730.44[医药卫生—肿瘤] R735.9[医药卫生—临床医学]