超声及超声造影在鉴别胰腺神经内分泌瘤与胰腺导管腺癌中的临床价值  

Clinical value of ultrasound and contrast enhanced ultrasound in the differential diagnosis of pancreatic neuroendocrine tumors and pancreatic ductal adenocarcinoma

作　　者：樊维娟 邓小倩 郑立春 欧阳向柳 FAN Weijuan;DENG Xiaoqian;ZHENG Lichun;OUYANG Xiangliu(Department of Ultrasound,Tangshan Central Hospital,Tangshan 063008,China;Department of Ultrasound,Tangshan Gongren Hospital,Tangshan 063003,China;Department of Nuclear Medicine,Tangshan Gongren Hospital,Tangshan 063003,China)

机构地区：[1]唐山中心医院超声医学科,河北唐山063008 [2]唐山市工人医院超声医学科,河北唐山063003 [3]唐山市工人医院核医学科,河北唐山063003

出　　处：《中国医科大学学报》2025年第4期359-363,共5页Journal of China Medical University

基　　金：河北省“三三三人才工程”项目(C20231084);唐山市科学技术研究与发展计划基金(19150220E)。

摘　　要：目的探讨超声及超声造影在胰腺神经内分泌瘤(PNET)与胰腺导管腺癌(PDAC)鉴别诊断中的临床价值。方法回顾性分析经病理确诊且临床资料、超声及超声造影资料完整的PNET患者74例,并选取74例PDAC患者作为对照组,比较2组患者的临床指标、超声及超声造影表现,2组间计量资料比较采用t检验,计数资料比较采用χ^(2)检验或Fisher’s确切概率法。结果74例PNET均为单发病灶,胰头18例、胰体26例、胰尾30例,PDAC也均为单发病灶,胰头52例、胰体8例、胰尾14例;在超声表现方面,PNET组病灶低回声、形态规则、边界清晰、胰管扩张或截断,血流信号所占比例分别为86.49%、83.78%、78.38%、18.92%、32.43%,PDAC组分别为94.59%、29.73%、27.03%、75.68%、21.62%,2组在病灶发病部位、形态是否规则、边界是否清晰、胰管是否扩张或截断方面差异有统计学意义(χ^(2)分别为31.862、44.048、39.141、47.815,P均<0.05),而在回声及血流信号方面差异无统计学意义(χ^(2)分别为2.840、2.193,P均>0.05)。52例PNET行超声造影检查,其中动脉期呈高增强表现38例,呈等增强表现14例,静脉期呈等增强表现40例,呈低增强表现12例;74例PDAC行超声造影检查,其中动脉期呈低增强表现70例、静脉期呈低增强表现72例。2组动脉期、静脉期的超声增强方式比较差异均有统计学意义(χ^(2)分别为56.582和37.852,P均<0.05)。结论PNET的超声及超声造影图像表现具有一定特征性,结合造影增强方式在与PDAC鉴别诊断中有一定临床价值。Objective To investigate the value of ultrasound and contrast enhanced ultrasound(CEUS)in the differential diagnosis of pancreatic neuroendocrine tumor(PNET)and pancreatic ductal adenocarcinoma(PDAC).Methods A retrospective analysis was performed on the clinical data,ultrasound findings,and CEUS findings of 74 patients with PNET and their characteristic manifestations were analyzed and compared with those of 74 patients with PDAC.Data of the two groups were compared using the t-test andχ^(2) test,or Fisher’s exact test.Results There were 18,26,and 30 patients with PNET lesions and 52,8,and 14 patients with PDAC located in the head,body,and tail of the pancreas,respectively.The patients with hypoechoic lesions,regular lesion morphology,clear boundaries,pancreatic duct dilatation or cutoff,and blood flow signal accounted for 86.49%,83.78%,78.38%,18.92%and 32.43%in the PNET group,respectively,whereas in the PDAC group,such patients accounted for 94.59%,29.73%,27.03%,75.68%and 21.62%,respectively.There was a significant intergroup differences in lesion location,morphology,boundaries and pancreatic duct dilatation or cutoff(χ^(2)=31.862,χ^(2)=44.048,χ^(2)=39.141,andχ^(2)=47.815,respectively,P<0.05),with no significant differences in hypoechoic and blood flow signal(χ^(2)=2.840 andχ^(2)=2.193,P>0.05).Among the 52 patients with PNET,CEUS showed that 38 had hyperenhancement and 14 had iso-enhancement in the arterial phase,whereas 40 had iso-enhancement and 12 had hypoenhancement in the venous phase.CEUS was performed in 74 patients with PDAC;70 patients showed hypoenhancement in the arterial phase and 72 showed hypoenhancement in the venous phase.There were significant differences in the enhancement pattern in the arterial and venous phases between the two groups(χ^(2)=56.582 andχ^(2)=37.852,P<0.05).Conclusion Ultrasound and CEUS revealed some characteristics of PNET that can be used for the differential diagnosis of PNET and PDAC,when combined with enhancement pattern.

关 键 词：胰腺肿瘤 神经内分泌瘤 胰腺导管腺癌 超声 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学]