一站式CT灌注成像联合增强扫描用于胰腺神经内分泌肿瘤

One-stop pancreas perfusion CT combined with enhancement in evaluation on pancreatic neuroendocrine neoplasms

目的探讨一站式CT灌注成像联合增强扫描对于胰腺神经内分泌肿瘤(pNEN)的应用价值。方法回顾30例接受一站式CT灌注成像联合增强扫描并经组织病理证实的pNEN患者,分析pNEN影像学特点,比较其灌注伪彩图灌注参数[血容量(BV)、血流量(BF)、平均通过时间(MTT)、毛细血管表面通透性(PS)]及时间-密度曲线(TDC),分析不同分级pNEN灌注参数差异和辐射剂量。结果灌注伪彩图显示pNEN病灶较正常实质呈明显高灌注状态,其BV、BF分别为(22.80±6.42)ml/100 g、(237.38±134.86)ml/(min·100 g),均高于正常实质(P均<0.05);MTT、PS分别为(7.03±3.48)s、(3.25±1.99)ml/(min·100 g),均低于正常实质(P均<0.05)。pNEN病灶早期显影时间为19.42~24.14 s,其TDC表现为速升后速降至平台期。依据不同pNEN级别,将pNEN病灶分为A组(G1级)和B组(G2/G3级),A组病灶PS为(4.48±2.21)ml/(min·100 g-),高于B组(2.23±1.34)ml/(min·100 g,P<0.05),组间BV、BF、MTT差别均无统计学意义(P均>0.05),PS与pNEN级别呈负相关(r=-0.52,P<0.01)。扫描全过程有效辐射剂量为(19.88±3.03)mSv。结论CT灌注联合增强扫描可依据病灶形态学表现及灌注参数诊断pNEN,并有助于常规增强CT扫描选择对可疑pNEN病灶的最佳扫描时间,且辐射剂量较低,并可根据PS预测肿瘤分级,对临床有一定指导意义。

Objective To explore the value of one-stop pancreas perfusion CT combined with enhancement in evaluation on pancreatic neuroendocrine neoplasms(pNEN).Methods A total of 30 patients with histopathologically proved pNEN who underwent one-stop pancreas perfusion CT combined with enhancement scan were collected.Imaging features of pNEN were analyzed,the perfusion parameters(blood volume[BV],blood flow[BF],mean transit time[MTT]and capillary surface permeability[PS])and tissue time density curve(TDC)were observed,the perfusion parameters were compared between different grades of tumors,and the efficacy of radiation dose was analyzed.Results Pseudo-color images showed that compared with surrounding pancreatic tissue,significantly higher-perfusion was observed in pNEN tissue,with BV of(22.80±6.42)ml/100 g,BF of(237.38±134.86)ml/(min·100 g),significantly higher than those of surrounding pancreatic tissue(both P<0.05).MTT of pNEN tissue was(7.03±3.48)s,PS was(3.25±1.99)ml/(min·100 g),both lower than surrounding pancreatic tissue(both P<0.05).The developing time of pNEN lesion was approximately 19.42-24.14 s.TDC showed a rapid ascending trend and then rapid decreasing to the plateau in pNEN tissue,whereas a slowly increasing to the peak value and then a slight decrease to the plateau in the normal tissue.According to histopathological grades,pNEN were divided into groups A(G1)and B(G2/G3).PS values of group A([4.48±2.21]ml/[min·100 g-])and B([2.23±1.34]ml/[min·100 g])were significantly different(P<0.05),while BV,BF and MTT values were not(all P>0.05).There was negative correlation between PS and tumor grade(r=-0.52,P<0.01).The total X-ray dose of whole scan was(19.88±3.03)mSv.Conclusion One-stop pancreas perfusion CT combined with enhancement scan can diagnose pNEN according to morphological features and perfusion parameters with small radiation dose,and PS parameters may distinguish pNEN grading preoperation.One-stop pancreas perfusion CT combined with enhancement scan is helpful to choice of optimal scanning time of suspicious pNEN lesions during conventional enhanced CT.