十二指肠神经内分泌肿瘤的CT表现分析

CT image features of duodenal neuroendocrine tumors

目的分析十二指肠神经内分泌肿瘤的CT影像学特点,提高对该少见病的认识。方法回顾性收集并分析经病理证实的12例十二指肠神经内分泌肿瘤患者的CT影像、病理结果及临床资料。12例患者中,男性7例,女性5例,年龄45~73岁,平均年龄58.9岁。观察者记录肿瘤的数目、大小、位置、形态、密度、强化特点及是否存在淋巴结或远处转移。结果12例中,1例为多发肿瘤,11例为单发肿瘤。肿瘤的最大径为0.5~2.7cm,平均最大径为1.7cm。位于十二指肠球部4例,降段4例,乳头部4例。3例肿瘤在CT图像未见明显病变显示,2例表现为肠壁的局部增厚,7例表现为腔内结节。CT图像可见的9例肿瘤平扫密度均较为均匀,增强扫描后,在动脉期强化达到峰值7例,在静脉期强化达到峰值2例,其中8例为明显强化。1例存在淋巴结肿大。4例伴有胆管扩张。结论十二指肠神经内分泌肿瘤多表现为十二指肠肠壁或肠腔内明显强化的结节或肿块,邻近增大的淋巴结是提示肿瘤存在的线索。

Objective The purpose of the study is to evaluate the CT appearance of pathologically confirmed duodenal neuroendocrine tumors,in order to improve the understanding of this rare tumor.Methods Clinical and pathological records and CT images of 12 patients(mean age,58.9 years;range,45~73 years)were retrospectively reviewed,including 7 men and 5 women.The number,size,location,morphology,enhancement pattern and the presence of lymph node or liver metastases were recorded.Results Of the 12 patients,1 had multiple lesions and 11 had single lesion.The maximum diameter ranged from 0.5 to 2.7cm(mean 1.7 cm).Four lesions were located in the duodenal bulb,4 lesions in the descending part,and 4 lesions in the papilla.In 3 patients,the primary tumor was not visualized on CT images.In 2 patients,the primary tumor manifested as an area of wall thickening or intramural lesion,and in 7 patients manifested as an polypoid or intraluminal masses in the duodenum.The visible 9 patients all had homogeneous lesions on unenhanced images.After enhancement,7 lesions peaked in arterial phase,and 2 lesions peaked in venous phase.Eight of them were obviously enhanced.Lymph node enlargement was found in 1 patient.Four lesions were accompanied by dilated bile duct.Conclusion Duodenal neuroendocrine tumors commonly appear as an obviously enhanced intramural or intraluminal lesion.Adjacent enlarged lymph node can be a clue to the existence of a duodenal neuroendocrine tumor.