多排螺旋CT在鉴别老年患者肿块型胰腺炎与胰腺导管腺癌中的应用价值  

Application value of multi⁃slice spiral CT in differentiating mass⁃forming pancreatitis from pancreatic ductal adenocarcinomain elderly patients

作　　者：张天雨 应晓燕 徐杰 李铭 李骋 Zhang Tianyu;Ying Xiaoyan;Xu Jie;Li Ming;Li Cheng(Department of Radiology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Radiology,Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai,200233,P.R.China)

机构地区：[1]复旦大学附属华东医院放射科,上海200040 [2]上海交通大学附属第六人民医院放射科,上海200233

出　　处：《老年医学与保健》2023年第4期732-737,共6页Geriatrics & Health Care

基　　金：上海卫健委-智慧医疗医学影像重大项目(2018ZHYL0103)。

摘　　要：目的 探讨多排螺旋CT在鉴别老年人肿块型胰腺炎(MFP)和胰腺导管腺癌(PDAC)的价值。方法 回顾性分析复旦大学附属华东医院2011年1月—2021年12月经临床手术/穿刺病理证实的24例肿块型胰腺炎与52例胰腺导管腺癌老年患者的临床及多排螺旋CT征象,采用独立样本t检验或χ^(2)检验对数据进行统计学分析,探究具有鉴别价值的临床及影像特征。结果 2组疾病的价值的CT征象包括:直接征象:MFP与PDAC患者病灶密度均匀者分别为18例(75%)和15例(28.85%),差异具有统计学意义(2=14.328,P<0.001);病灶CT值方面:在增强扫描后,MFP组病灶的强化程度总体高于PDAC组,MFP组与PDAC组病灶动脉期CT值分别为(59.4±10.5)HU和(53.8±11.5)HU,静脉期CT值分别为(85.8±13.8)HU和(78.9±14.0)HU,差异均有统计学意义(t=2.024/2.011,P=0.047/0.048);间接征象:PDAC更容易出现胰周血管侵犯(36.54%)、胰尾部萎缩(53.85%)和远处转移征象(17.31%),比例均高于MFP,差异均有统计学意义(2=4.613/5.527/4.712,P=0.032/0.019/0.003)。结论 多排螺旋CT征象包括动静脉期病灶CT值、血管侵犯、胰尾部萎缩、远处转移征象等在老年MFP和PDAC中具有一定的鉴别价值。Objective To evaluate the value of multi⁃slice spiral CT in differentiating mass⁃forming pancreatitis(MFP)from pancreatic ductal adenocarcinoma(PDAC)in elderly patients.Methods The clinical and multi⁃slice spiral CT findings of 24 elderly patients with MFP and 52 elderly patients with PDAC confirmed by clinical operation/biopsy pathology in Hua⁃dong Hospital Affiliated to Fudan University were retrospectively analyzed.The data were statistically analyzed by independent sample t test orχ2 test to explore the clinical and imaging features with differential value.Results The valuable CT signs of the 2 groups included:direct signs:18 cases(75%)of MFP patients and 15 cases(28.85%)of PDAC patients had uniform lesion density,and the difference was statistically significant(χ^(2)=14.328,P<0.001).In terms of CT value of lesions:after enhanced scanning,the enhancement degree of lesions in the MFP group was generally higher than that in the PDAC group.In arterial phase,the CT values of lesion of the MFP group and PDAC group were(59.4±10.5)HU and(53.8±11.5)HU,respectively.In venous phase,the CT values of lesion of the MFP group and PDAC group were(85.8±13.8)HU,(78.9±14.0)HU,respectively.The differences were statistically significant(t=2.024/2.011,P=0.0.47/0.048).Indirect signs:PDAC was more likely to have peripancreatic vascular invasion(36.54%),pancreatic tail atrophy(53.85%),and distant metastasis signs(17.31%),with a higher proportion than MFP,and the differences were statistically significant(2=4.613/5.527/4.712,P=0.032/0.019/0.003).Conclusion Multi⁃slice spiral CT features including arteriovenous lesions,vascular invasion,pancreatic tail atrophy and distant metastasis have certain differential value in elderly patients with MFP and PDAC.

关 键 词：老年 螺旋CT 肿块型胰腺炎 胰腺导管腺癌 

分 类 号：R735.9[医药卫生—肿瘤]