定量分析钙化和囊变鉴别肿块型慢性胰腺炎与胰腺导管腺癌  

Quantitative analysis of calcification and cystic degeneration in differentiating mass-forming chronic pancreatitis from pancreatic ductal adenocarcinoma

作　　者：夏小梅 阮志兵 陈慧淋 文凤 陈坤 石士晗 XIA Xiaomei;RUAN Zhibing;CHEN Huilin;WEN Feng;CHEN Kun;SHI Shihan(College of Medical Imaging,Guizhou Medical University,Guiyang 550004,China;Department of Radiology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学医学影像学院,贵州贵阳550004 [2]贵州医科大学附属医院放射科,贵州贵阳550004

出　　处：《医学影像学杂志》2024年第11期87-91,共5页Journal of Medical Imaging

基　　金：贵州医科大学附属医院临床研究课题资助项目(编号:2021-GMHCT-021,gyfynsfc-2021-39)。

摘　　要：目的定量分析肿块内钙化和囊变,探讨量化指标钙化体积与主观评估钙化及囊变CT征象在鉴别肿块型慢性胰腺炎(MFCP)与胰腺导管腺癌(PDAC)中的价值及其诊断效能的差异。方法选取103例MFCP患者(MFCP组)与188例PDAC患者(PDAC组)的临床及CT资料,重点分析肿块内钙化及囊变CT征象,并基于软件定量分析技术提取肿块内钙化体积及测量最大囊直径,对两组数据进行统计学分析,ROC曲线评估钙化发生率、囊变发生率及钙化体积在鉴别MFCP与PDAC的诊断效能。结果1)肿块钙化:MFCP组与PDAC组钙化发生率分别为54.4%与10.1%,差异有统计学意义(P<0.001);MFCP组以混合型钙化、多发且弥漫分布为主,PDAC组以少许斑点状、结节状钙化且中心分布为主;两者钙化体积(cm3)Median(IQR)分别为1.16(0.55,2.54)与0.12(0.06,0.24),差异有统计学意义(P<0.001);2)肿块囊性灶:MFCP组与PDAC组囊变发生率分别为77.7%与48.9%,差异有统计学意义(P<0.001),其中蜂窝状囊性灶仅见于MFCP组,发生率为16.5%,MFCP组囊性灶多饱满有张力,18例囊壁钙化;PDAC组囊性灶表现形式多样(囊实性24例、单纯囊性灶5例),1例囊壁钙化;两组在多发囊发生率、最大囊直径比较差异无统计学意义(P>0.05);3)ROC评价:两组在钙化发生率、囊变发生率及钙化体积的AUC值分别为0.726、0.664、0.876,钙化体积最佳截断值为0.32cm^(3),当钙化体积>0.32 cm^(3)时提示为MFCP。结论钙化与囊变CT征象有助于MFCP与PDAC鉴别,定量指标钙化体积具有更好鉴别诊断效能,多发、弥漫分布混合型钙化与饱满具有张力的蜂窝状囊性灶有助于诊断MFCP,钙化体积>0.32cm3时提示为MFCP。Objective To quantitatively analyze the calcification and cystic changes in the mass,and to explore the value of quantitative index calcification volume and subjective evaluation of calcification and cystic CT signs in the differential diagnosis of mass-forming chronic pancreatitis(MFCP)and pancreatic ductal adenocarcinoma(PDAC)and the difference in diagnostic efficacy.Methods The clinical and CT data of 103 patients with MFCP and 188 patients with PDAC were collected,and the CT signs of calcification and cystic degeneration in the mass were analyzed.Based on the software quantitative analysis technology,the calcification volume in the mass was extracted and the maximum cyst diameter was measured.The data of the two groups were statistically analyzed.The ROC curve was used to evaluate the diagnostic efficacy of the incidence of calcification,the incidence of cystic degeneration and the volume of calcification in differentiating MFCP from PDAC.Results 1)Mass calcification:The incidence of calcification in the MFCP group and the PDAC group was 54.4% and 10.1%,respectively,and the difference was statistically significant(P<0.001).The MFCP group was dominated by mixed calcification,multiple and diffuse distribution,and the PDAC group was dominated by a few spotted,nodular calcification and central distribution.The calcification volume(cm3)Median(IQR)was 1.16(0.55,2.54)and 0.12(0.06,0.24),respectively,and the difference was statistically significant(P<0.001).2)Cystic lesions:The incidence of cystic lesions in MFCP group and PDAC group was 77.7% and 48.9%,respectively,and the difference was statistically significant(P<0.001).Among them,honeycomb cysts were only found in the MFCP group,with an incidence of 16.5%.The cystic lesions in the MFCP group were full of tension,and 18 cases of cystic wall calcification.The cystic lesions in the PDAC group showed various forms(24 cases of cystic solid and 5 cases of simple cystic lesions),and 1 case of cystic wall calcification.There was no significant difference in the incidence

关 键 词：肿块型慢性胰腺炎 胰腺导管腺癌 钙化 囊变 体层摄影技术 X线计算机 

分 类 号：R657[医药卫生—外科学] R814.42[医药卫生—临床医学]