动态增强CT在腹腔间质瘤和神经内分泌瘤鉴别诊断中的应用价值

The Value of Dynamic Contrast-Enhanced CT in Differential Diagnosis of Abdominal Stromal Tumors and Neuroendocrine Tumors

目的探讨动态增强CT在腹腔间质瘤和神经内分泌瘤鉴别诊断中的应用价值。方法回顾性分析经病理或免疫组织化学证实30例间质瘤及30例神经内分泌瘤患者的临床及CT动态增强检查资料并测量其各期CT值。采用SPSS 17.0软件进行统计学分析,同一种肿瘤增强各期CT值的比较使用单因素方差分析,两种肿瘤同期两两比较均采用配对样本t检验,P<0.05为差异有统计学意义。对差异有统计学意义者绘制受试者工作特性(ROC)曲线,分析动态增强CT对腹腔间质瘤和神经内分泌瘤的诊断效能,并确定曲线下面积(AUC)值及对应的敏感度和特异度。结果间质瘤增强三期的CT值比较差别有统计学意义(F=11.91,P<0.001),两两比较结果显示,动脉期与静脉期CT值比较差别有统计学意义(P<0.001),静脉期CT平均值>动脉期CT平均值;动脉期与延迟期CT值比较差别有统计学意义(P<0.001),延迟期CT平均值>动脉期CT平均值;延迟期与静脉期CT值比较差别无统计学意义(P=0.311)。神经内分泌瘤增强三期的CT值比较差别无统计学意义(F=0.309,P=0.735)。神经内分泌瘤与间质瘤的CT值动脉期比较差异有统计学意义(t=6.262,P<0.001),神经内分泌瘤与间质瘤的CT值静脉期比较差异有统计学意义(t=5.832,P<0.001),神经内分泌瘤与间质瘤的CT值延迟期比较差异有统计学意义(t=3.792,P=0.001)。腹腔间质瘤和神经内分泌瘤动脉期诊断效能最高,AUC为0.853,最佳的截断值为55.06 HU,敏感度为83.0%,特异度为74.5%。结论间质瘤三期强化特点为持续强化为主,延迟期可以出现持平或下降;神经内分泌瘤在各期的CT值均高于间质瘤且动脉期的CT值若低于55.06 HU则间质瘤的可能性大,这些CT特点在腹腔间质瘤和神经内分泌瘤鉴别诊断中有一定的应用价值。

Objective To investigate the value of dynamic contrast-enhanced CT in differential diagnosis of abdominal stromal tumors and neuroendocrine tumors.Methods 30 cases of stromal tumors and 30 cases of neuroendocrine tumors confirmed by pathology or immunohistochemistry were retrospectively analysed.Both the clinical and CT dynamic enhancement data were collected and the CT values of each stage were measured.Statistical analysis was performed by SPSS 17.0,and ANOVA was used to compare the CT values of the same tumor at different phases.The t-test was used for the two tumors at the same phase.P<0.05 was considered statistically significant.Results(1)There was a statistically significant difference in CT values between the three phases of stromal tumors.The enhancement was characterized by continuous enhancement,ie,delayed phase>arterial phase,venous phase>arterial phase,but there was no difference between delayed phase and venous phase.(2)There was no statistical difference in CT values between the various stages of neuroendocrine tumors,and the enhancement methods were diverse.(3)The CT values of neuroendocrine tumors in all three phases were higher than those in stromal tumors.Conclusion The stromal tumors were characterized by continuous enhancement,The delayed phases can be flat or decreased in the delayed phase.The CT values of neuroendocrine tumors in all phases are higher than those of stromal tumors.These CT features have certain application value in the differential diagnosis of abdominal stromal tumors and neuroendocrine tumors.