MSCT对胰腺实性假乳头状瘤与乏血供神经内分泌肿瘤的鉴别诊断

Differentiation of solid pseudopapillary neoplasm and hypovascular pancreatic neuroendocrine tumors by MSCT

目的:探讨MSCT对胰腺实性假乳头状瘤(SPN)与胰腺乏血供神经内分泌肿瘤(hypoPNET)的鉴别诊断价值。方法:回顾性分析经病理证实的26例SPN与14例hypo-PNET患者的临床及影像学资料,分析两组患者年龄、性别、病灶大小、部位、形态、边界、密度、各期增强扫描CT值、特征性征象(如"浮云征"、钙化、胰胆管扩张等)的显示率、邻近组织受侵或远处转移情况等。结果:SPN组患者的平均年龄为36.2岁,hypo-PNET组患者的平均年龄为46.2岁,两组患者年龄差异有统计学意义(P<0.05)。SPN组患者出现"浮云征"(42.3%)及钙化(42.3%)的概率均高于hypo-PNET组患者(7.1%、7.1%),差异有统计学意义(P<0.05);hypo-PNET组患者发生转移或局部侵犯的概率(28.6%)高于SPN组患者(3.8%),差异有统计学意义(P<0.05);有无胰胆管扩张、病灶各期CT值在两组中的差异无统计学意义;联合年龄、"浮云征"、钙化、转移等多因素进行ROC曲线分析,其ROC图的曲线下面积为0.854,对于鉴别两种病变的敏感度、特异度分别为92.9%、65.4%。结论:SPN组患者较hypo-PNET组患者更年轻;两组患者可出现不同程度的影像征象重叠,容易误诊;"浮云征"、钙化、转移等征象有助于两者的鉴别诊断。

Objective: To investigate the value of MSCT for differentiation of solid pseudopapillary neoplasm (SPNs) form hypovascular pancreatic neuroendocrine tumors (hypo-PNETs). Methods: Twenty-six histologically confirmed SPNs and fourteen histological-confirmed hypo-PNETs were recruited in this study.All patients underwent preoperative dynamic contrast CT.The clinical data and CT images were reviewed including tumor location,size,boundary,involvement of the pancreatic duct and bile duct,"Floating cloud" sign,calcification,local invasion or distant metastases and clinical features.CT values of pancreatic lesion in unenhancement and enhancement images were measured. Results: SPNs usually occurred in young women compared with hypo-PNETs (mean age,36.2 vs 46.2, P < 0.005).SPNs usually showed the "Floating cloud" sign,calcification,lower metastastic rates compared with hypo-PNETs (42.3% vs 7.1%,42.3% vs 7.1%,3.8% vs 28.6%,respectively, P <0.05 for all).However,the involvement of the pancreatic duct and CT values showed no significant difference.The combined features (younger age and "Floating cloud" sign,calcification) provide acceptable diagnostic performance (92.9% of sensitivity and 65.4% of specificity) for differentiation of SPNs from hypo-PNETs. Conclusion:"Floating cloud" sign,calcification,local invasion and distant metastases may be valuable for differentiation of SPNs from hypo-PNETs.