胰腺实性假乳头状瘤的CT表现及良、恶性鉴别

Differentiation between benign and malignant solid pseudopapillary tumors of the pancreas by computed tomography scan

背景与目的:胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)在临床上较为少见,良恶性SPTP的治疗方法及预后存在差异。该研究旨在探讨良恶性SPTP的CT影像学表现特征及鉴别诊断,以提高术前诊断的准确性。方法:回顾性分析了69例经手术切除及病理学证实的胰腺实性假乳头状瘤患者的临床资料及CT表现,由3位放射诊断学医师比较分析两组患者影像学表现,联系其临床表现及病理结果进行良恶性鉴别。结果:恶性组患者共13例(18.84%),其中女性9例(69.23%),男性4例(30.77%)。良性组患者共56例(81.16%),其中女性45例(80.36%),男性11例(19.46%),两组患者性别比例差异无统计学意义(P=0.458)。恶性组患者平均年龄为39(16~56)岁,明显大于良性组患者的31(14~56)岁(P=0.001)。恶性组肿瘤最大径均值为6.2(2.2~12.0)cm,良性组肿瘤最大径均值为5.5(1.2~13.0)cm(P=0.435)。31例肿瘤最大径大于等于5 cm,其中恶性组10例(76.92%),良性组21例(37.50%)(P=0.014)。28例肿瘤包膜不完整,其中恶性组9例(69.23%),良性组19例(33.93%)(P=0.028)。两组肿瘤在部位、形态、囊实性比例、钙化及强化方式的差异均无统计学意义(P>0.05)。结论:恶性SPTP患者年龄大于良性患者,且肿瘤最大径大于等于5 cm及包膜不完整是恶性SPTP相对特征性的影像学表现。

Background and purpose： Solid pseudopapillary tumor of the pancreas （SPTP） is rare, and there are some differences between benign and malignant SPTP not only in clinical treatment but also in future prognosis. The purpose of this study was to investigate the characteristics of benign and malignant SPTP and differential diagnosis on computed tomography scan, in order to improve the accuracy of preoperative diagnosis. Methods： A total of 69 SPTP patients cofirmed by pathology were included. Each patient was diagnosed through the clinical and CT features by 3 radiologists. Results： Thirteen （18.84%） patients （9 females and 4 males） were confirmed as malignant SPTP. The tumors in 56 （81.16%） patients （45 females and 11 males） were diagnosed as benign SPTP. There was no significant difference in gender （P=0.458） between the groups. The mean age of malignant SPTP patients was significantly higher than that of benign SPTP patients [39 （16-56） years vs 31 （14-56） years, P=0.001]. The mean tumor size was 6.2（2.2-12.0）cm in malignant group and 5.5（1.2-13.0） cm in benign group, respectively. The size of tumor was equal or larger than 5.0 cm in 31 patients （benign vs malignant 21∶10, P=0.014）. Twenty-eight lesions showed incomplete fibrous pseudocapsule （benign vs malignant 19∶9, P=0.028）. There were no significant differences in lesion location, morphology, proportion of cystic or solid component between malignant and benign groups （P〉0.05）. Conclusion： Malignant SPTP patients were significantly older than benign SPTP patients. The large tumor size （≥5 cm） and incomplete fibrous pseudocapsule may suggest malignancy of SPTP.