胰腺实性假乳头状瘤与非功能性神经内分泌肿瘤的多层螺旋CT鉴别诊断

Differentiate solid psuedopapillary tumors of pancreas and non-functional pancreatic neuroendocrine tumors with multi-slice spiral CT

目的分析胰腺实性假乳头状瘤(SPTP)与非功能性胰腺神经内分泌肿瘤(NFPNET)的多层螺旋CT表现,探讨多层螺旋CT对两者的鉴别诊断价值。方法收集2013年5月—2018年8月术后经病理确诊的22例SPTP病人[男4例,女18例;年龄15～51岁,平均(31.5±10.1)岁]及12例NFPNET病人[男4例,女8例;年龄49～79岁,平均(56.8±14.2)岁],术前均行CT腹部平扫和增强扫描。采用Fisher确切概率法对2组的病灶位置、密度、钙化、钙化位置、边界、强化峰值出现时相、环形强化、导管扩张及远处转移进行比较,采用独立样本t检验对2组的病灶长径、强化幅度进行比较。结果 NFPNET组发病年龄[(56.8±14.2)岁]高于SPTP组[(31.5±10.1)岁](t=-5.454,P=0.001)。2组的边界、有无钙化、强化峰值出现时相、强化幅度、有无远处转移间差异均有统计学意义(均P<0.05)。SPTP组边界较NFPNET组清晰;NFPNET组肿瘤钙化者少于SPTP组;SPTP组强化峰值多出现于门静脉期,而NFPNET组强化峰值多见于动脉期,且强化幅度较SPTP组高。NFPNET组发生远处转移者多于SPTP组。2组间肿瘤的位置、长径、密度、钙化位置、有无环形强化、有无导管扩张间差异均无统计学意义(均P>0.05)。结论多层螺旋CT检查对胰腺实性假乳头状瘤及非功能性神经内分泌肿瘤具有鉴别诊断价值。

Objective To analyze the manifestations of solid pseudo-papillary tumors of pancreas(SPTP)and nonfunctional pancreatic neuroendocrine tumors(NFPNET)on multi-slice spiral CT,and to explore the differential diagnostic values of the CT technique.Methods 22 patients with solid pseudo-papillary tumors of pancreas(4 males and 18 females,mean age 31.5±10.1 years with range 15-51 years)and 12 patients with non-functional pancreatic neuroendocrine tumors(4 males and 8 females,mean age 56.8±14.2 years with range 49-79 years)were collected from May 2013 to August 2018.All patients underwent abdominal plain CT scan and enhanced scan before operation.Fisher exact test was used to compare the differences in location,density,calcification,location of calcification,boundary,peak phase of enhancement,presence of ring-like enhancement,catheter expansion,and distant metastasis between the two groups.Independent-sample t test was used to compare the differences in long diameter and enhancement magnitude between the two groups.Results The age of the NFPNET group(56.8+14.2 years)was significantly higher(t=-5.454,P=0.001)than that of the SPTP group(31.5+10.1 years).There were statistical significances in the boundaries,presence or absence of calcification,peak phase of enhancement,enhancement magnitude,presence or absence of distant metastasis between the two groups(P<0.05).The boundary of the SPTP group was clearer than that of the NFPNET group.The number of calcified tumors in the NFPNET group was less than that in the SPTP group.In the SPTP group,the peak enhancement occurred mostly in portal venous phase,while in the NFPNET group,the peak enhancement occurred mostly in arterial phase,and the enhancement magnitude were higher than that in the SPTP group.Distant metastases occurred more often in the NFPNET group than in the SPTP group.There were no statistical significances in the location,long diameter,density,location of calcification,presence or absence of ring-like enhancement,and presence or absence of catheter expansion between the two groups(P>0.05).Conclusion Multi-slice spiral CT has diagnostic value for differentiating SPTP and NFPNET.