胰腺神经内分泌癌的MRI表现及治疗

MRi manifestations and treatment of pancreatic neuroendocrine carcinoma

目的分析胰腺神经内分泌癌(pancreatic neuroendocrine carcinoma,pNEC)的MRI表现及临床特点,以提高诊治水平。方法回顾性分析7 例经病理学证实pNEC的MRI及临床资料,并复习相关文献。结果 7例均为单发,其中位于胰尾5例,胰体1例,胰头1例。6例类圆形,1例不规则分叶状。病灶直径约2.2~11.6 cm,平均5.9 cm。MRI平扫7 例T1WI上呈低信号,T2WI稍高信号,DWI明显高信号。增强动脉期6 例呈轻-中度强化,1 例轻度强化,静脉期均持续强化。7 例强化不均匀,内部均见无强化坏死区,5 例见不完整的假包膜;4 例累犯胰周结构,3 例见肝脏转移。7 例均经手术治疗,其中5 例行根治性切除术,2例行姑息手术,术后均辅助全身化疗。术后分别随访至14~65 个月,5 例存活,2 例死亡。结论 pNEC的MRI表现具有一定特征,MRI对其诊断及鉴别具有较大价值,手术切除辅以化疗是其主要治疗方法,预后一般好于胰腺导管癌。

Objective To analyze MRI manifestations and clinical features of pancreatic neuroendocrine carcinoma (pNEC), so as to improve the level of diagnosis and treatment. Methods The MRI and clinical data of 7 patients with pNEC that was confirmed by pathology were retrospectively analyzed, and related literatures were reviewed. Results All 7 cases were presented as single mass. Among them, 5 was located at pancreas tail, 1 at body and 1 at the head. Six pNECs were round-like and 1 was in irregular lobulation. Diameter of 7 lesions ranged from 2.2 cm to 11.6 cm and the mean diameter was 5.9 cm. On unenhanced MRI, 7 cases showed low signal on T1WI, mild high signal on T2WI and obvious high signal on DWI. In enhanced arterial phase, 6 cases showed mild to moderate enhancement, 1 case showed mild enhancement;7 cases showed continuous enhancement in venous phase. The enhancement of all 7 cases were heterogeneous, and inside necrosis can be observed. Incomplete pseudocapsule was observed in 5 cases, involvement of peri-pancreatic structures was observed in 4 cases and hepatic metastasis was observed in 3 cases. All 7 patients received surgical treatment (radical resection in 5 cases and palliative operation in 2 cases) and the auxiliary systemic chemotherapy was given after operation. Postoperative follow-up of 14~65 months, 5 patients survived and another 2 patients died. Conclusion MRI manifestations of pNEC have certain characteristics and MRI provides significant value in diagnosing and distinguishing pNEC. Surgical resection assisted by chemotherapy is the main therapeutic method and its prognosis is generally better than that of pancreatic ductal carcinoma.