胰腺实性假乳头状肿瘤与乏血供胰腺神经内分泌瘤的多层螺旋计算机断层扫描鉴别特征  

Differential characteristics of multislice spiral computed tomography between pancreatic solid pseudopapillary neoplasm and hypovascular pancreatic neuroendocrine tumor

作　　者：李正腾 张佩玉 纪元 曾蒙苏 王明亮 Li Zhengteng;Zhang Peiyu;Ji Yuan;Zeng Mengsu;Wang Mingliang(Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Jining No.1 People′s Hospital,Jining 272000,China)

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]复旦大学附属中山医院病理科,上海200032 [3]济宁市第一人民医院放射科,济宁272000

出　　处：《中华消化杂志》2022年第7期452-457,共6页Chinese Journal of Digestion

基　　金：上海市临床重点专科项目(shslczdzk03202);上海市卫生健康委员会卫生行业临床研究项目(202140290)。

摘　　要：目的探讨多层螺旋计算机断层扫描(MSCT)特征在鉴别胰腺实性假乳头状肿瘤(pSPN)与乏血供胰腺神经内分泌瘤(hypo-PNET)的价值。方法回顾性分析复旦大学附属中山医院2016年1月至2021年1月经手术病理证实的81例pSPN和40例hypo-PNET患者的临床信息、病理结果、影像学检查资料,对比分析pSPN和hypo-PNET患者的肿瘤部位、形状、生长方式、病灶长轴与胰腺的关系、边界,有无钙化、浮云征、环形强化、腊肠样强化、肿瘤内血管影、胰胆管扩张、远端胰腺萎缩、肿瘤内囊变,肿瘤囊实性比例、肿瘤长径,以及平扫和增强扫描检查时肿瘤实性部分的计算机断层扫描(CT)值。采用卡方检验、独立样本t检验、Mann-WhitneyU检验进行统计学分析。应用二元logistic回归模型筛选出pSPN和hypo-PNET的独立预测因素,并采用受试者操作特征曲线(ROC)分析MSCT特征鉴别pSPN与hypo-PNET的诊断效能。结果pSPN患者与hypo-PNET患者相比,多为女性[71.6%(58/81)比45.0%(18/40)],年龄较小[36.0岁(27.0岁,46.0岁)比56.5岁(48.2岁,63.7岁)],肿瘤多呈类圆形或椭圆形[76.5%(62/81)比55.0%(22/40)]、边界清楚[70.4%(57/81)比40.0%(16/40)],有钙化、有浮云征、无肿瘤内血管影、无胰胆管扩张、呈囊实性比例较高[53.1%(43/81)比20.0%(8/40)、65.4%(53/81)比35.0%(14/40)、77.8%(63/81)比32.5%(13/40)、79.0%(64/81)比55.0%(22/40)、38.3%(31/81)比22.5%(9/40)],肿瘤长径较大[4.0 cm(3.0 cm,5.6 cm)比3.3 cm(2.6 cm,4.2 cm)],动脉期和静脉期增强扫描的CT值较小[分别为(54.7±13.1)HU比(68.2±15.0)HU、(65.9±16.0)HU比(79.2±14.2)HU],差异均有统计学意义(χ^(2)=8.11,Z=-6.24,χ^(2)=5.85、10.32、12.02、10.03、23.50、7.51、7.72,Z=-2.53,t=-5.08、-4.46;均P<0.05)。二元logistic回归模型分析结果显示,诊断pSPN和hypo-PNET的独立预测因素包括年龄[OR=0.874,95%置信区间(95%CI)0.827~0.923,P<0.001]、钙化(OR=5.412,95%CI 1.428~20.506,P=0.013)、肿瘤内血管影(OR=0.212Objective To investigate the value of multislice spiral computed tomography(MSCT)features in the differential diagnosis of pancreatic solid pseudopapillary neoplasm(pSPN)and hypovascular pancreatic neuroendocrine tumor(hypo-PNET).Methods From January 2016 to January 2021,at Zhongshan Hospital of Fudan University,the clinical information,pathological results and imaging data of 81 patients with pSPN and 40 patients with hypo-PNET confirmed by surgical pathology were retrospectively analyzed.The tumor location,shape,growth mode,relationship between the long axis of the lesion and pancreas,boundary,whether with calcification,floating cloud sign,ring enhancement,sausage-like enhancement,intratumoral vascular sign,pancreatic duct dilatation,distal pancreatic atrophy,intratumoral cystic change,cystic-solid ratio of tumor,the maximum diameter of the lesion,the plain and enhanced computed tomography(CT)values of the solid part of the tumor of pSPN patients and hypo-PNET patients were compared and analyzed.Chi-square test,independent sample t test and Mann-Whitney U test were used for statistical analysis.The variables with statistical significance in univariate analysis were included in the binary logistic regression model to screen the independent predictors of pSPN and hypo-PNET,and the receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficiency of MSCT characteristics in the differential diagnosis of pSPN and hypo-PNET.Results Compared with hypo-PNET patients,most of pSPN patients were female(71.6%,58/81 vs.45.0%,18/40),younger 36.0 years old(27.0 years old,46.0 years old)vs.56.5 years old(48.2 years old,63.7 years old),the tumors were mostly round or elliptical(76.5%,62/81 vs.55.0%,22/40),most with clear boundaries(70.4%,57/81 vs.40.0%,16/40),with more intratumoral calcification(53.1%,43/81 vs.20.0%,8/40),with more floating cloud sign(65.4%,53/81 vs.35.0%,14/40),more without intratumoral vascular sign(77.8%,63/81 vs.32.5%,13/40),more without pancreatic duct dilatation(79.0%,64/81 vs.55.

关 键 词：胰腺 实性假乳头状肿瘤 神经内分泌瘤 体层摄影术 X线计算机 

分 类 号：R735.9[医药卫生—肿瘤]