超声造影定量分析鉴别胰腺神经内分泌肿瘤与胰腺癌

CEUS quantitatively differentiating pancreatic neuroendocrine tumors from pancreatic carcinoma

目的探讨CEUS时间-强度曲线（TIC）定量参数鉴别胰腺神经内分泌肿瘤与胰腺癌的临床价值。方法回顾获病理诊断的43例神经内分泌肿瘤和胰腺癌的CEUS检查图像,并对其动态图像进行TIC定量分析,得出峰值强度（IMAX）、到达时间（AT）、达峰时间（TTP）、平均渡越时间（mTT）。结果 16例神经内分泌肿瘤与周围胰腺比较,各项定量参数差异均无统计学意义（P均〉0.05）,其中12例呈高及等增强型神经内分泌肿瘤IMAX与周围胰腺差异有统计学意义[（146.38±60.35）%vs 100%,P=0.02）]。27例胰腺癌TIC参数与周围胰腺比较：胰腺癌IMAX小于周围胰腺[（59.12±26.17）%vs 100%,P〈0.01],AT大于周围胰腺[（14.50±6.83）s vs（11.87±4.51）s,P=0.01],mTT小于周围胰腺[33.30（26.00-73.70）s vs 45.00（35.00-150.10）s,P=0.11）。神经内分泌肿瘤与胰腺癌比较：神经内分泌肿瘤IMAX大于胰腺癌,TTP小于胰腺癌,mTT大于胰腺癌（P均〈0.05）。以IMAX≥97.05%诊断神经内分泌肿瘤准确率、敏感度、特异度、阳性预测值、阴性预测值,分别为86.05%（37/43）、75.00%（12/16）、92.60%（25/27）、85.71%（12/14）、86.20%（25/29）。联合TTP≤7.70s、mTT≥38.80s诊断指标,可提高神经内分泌肿瘤的诊断效率。结论 CEUS定量分析可获得胰腺神经内分泌肿瘤和胰腺癌鉴别诊断的定量化指标,可为两者鉴别诊断提供更客观、有力证据。

Objective To explore the clinical value of time-intensity curve（TIC）with CEUS in differential diagnosis of pancreatic neuroendocrine tumors from pancreatic carcinoma.Methods CEUS imaging of 16 patients with pancreatic neuroendocrine tumors and 27 patients with pancreatic carcinoma were retrospectively analyzed.All patients had pathological results.The maximum intensity（IMAX）,arrival time（AT）,time to peak（TTP）,mean transit time（mTT）were calculated with TIC.Results Comparing TIC parameters of pancreatic neuroendocrine tumors with adjacent pancreatic tissue,every parameter had no statistical differences with adjacent pancreatic tissue（all P〉0.05）.IMAX of 12 cases of hyper-and iso-enhanced pancreatic neuroendocrine tumors had significant differences with adjacent pancreas（[146.38±60.35]% vs100%,P=0.02）.IMAX of pancreatic carcinoma was smaller than that of adjacent pancreatic tissue（[59.12±26.17]%vs 100%,P〈0.01）,AT was larger than that of adjacent pancreatic tissue（[14.50±6.83]s vs [11.87±4.51]s,P=0.01）,mTT was smaller than that of adjacent pancreatic tissue（33.30 [26.00—73.70]s vs 45.00 [35.00—150.10]s,P=0.11）.Comparing TIC parameters of pancreatic neuroendocrine tumors with pancreatic carcinoma,IMAX of pancreatic neuroendocrine tumors was larger,TTP was smaller,mTT was larger than those of pancreatic carcinoma（all P〉0.05）.Using IMAX≥97.05%as diagnostic indicator for differentiating pancreatic neuroendocrine tumors from pancreatic carcinoma,the diagnostic accuracy,sensitivity,specificity,positive predictive value,negative predictive value were 86.05%（37/43）,75.00%（12/16）,92.60%（25/27）,85.71%（12/14）,86.20%（25/29）respectively.Combining diagnostic indicators of TTP≤7.70 sand mTT≥38.80 s,diagnostic efficiency increased.Conclusion CEUS can provide quantitative criterions for the differentiation of pancreatic neuroendocrine tumors from pancreatic carcinoma,which proves objective and effective evidence for their differentiation.