基于多排螺旋CT影像特征的胰腺腺泡细胞癌与胰腺导管腺癌的鉴别诊断

The differential diagnosis of pancreatic acinar cell carcinoma and pancreatic ductal adenocarcinoma based on multidetector computed tomography features

目的探讨基于多排螺旋CT(MDCT)影像特征的胰腺腺泡细胞癌(PACC)与胰腺导管腺癌(PDAC)的鉴别诊断。方法回顾性分析2013年11月至2021年4月间海军军医大学第一附属医院经手术病理证实的26例PACC(PACC组)和145例胰腺导管腺癌(PDAC组)患者的临床、病理学和影像学资料,比较两组患者的肿瘤位置、肿瘤大小、主胰管扩张、胆总管扩张、胰腺炎、淋巴结转移、囊肿、实质萎缩、侵犯十二指肠、侵犯胆总管及血管侵犯等影像特征,单因素及多因素logistic回归分析诊断PACC的独立预测因子。结果PACC组与PDAC组的肿瘤大小、胆总管扩张、淋巴结转移、实质萎缩、血管侵犯的差异均有统计学意义(P值均<0.05)。多因素回归分析结果显示,肿瘤大小(OR=1.07,95%CI1.028~1.105,P=0.001)、淋巴结转移(OR=0.23,95%CI0.065~0.800,P=0.02)、实质萎缩(OR=0.15,95%CI0.048~0.490,P=0.002)与PACC呈显著相关。结论依据MDCT影像特征评估的肿瘤大小、胆管扩张、淋巴结转移、实质萎缩、血管侵犯在PACC与PDAC的鉴别诊断中具有一定价值,其中肿瘤大小、淋巴结转移、实质萎缩是诊断PACC的独立预测因素。

Objective To explore the differential diagnosis of pancreatic acinar cell carcinoma(PACC)and pancreatic ductal adenocarcinoma(PDAC)based on multidetector computed tomography(MDCT)features.Methods The clinical,pathological and MDCT imaging data of 26 patients with pathologically confirmed PACC and 145 patients with pathologically confirmed PDAC who underwent MDCT from November 2013 to April 2021 were retrospectively studied.The differences of MDCT features including tumor location,tumor size,common pancreatic duct and bile duct dilatation,pancreatitis,lymph node metastasis,cyst,pancreatic parenchyma atrophy,duodenal involvement,bile ductal and vascular involvement between the two groups were compared.Univariate analysis and multivariate analysis by logistic regression models were performed to identify the independent predictive factors for PACC.Results The tumor size,bile duct dilatation,lymph node metastasis,pancreatic parenchyma atrophy and vascular involvement were significantly different between PACC group and PDAC group(all P value<0.05).Multivariate analysis revealed that the tumor size(OR=1.07,95%CI 1.028-1.15,P=0.001),lymph node metastasis(OR=0.23,95%CI 0.065-0.800,P=0.02),pancreatic parenchyma atrophy(OR=0.15,95%CI 0.048-0.490,P=0.002)were closely associated with PACC.Conclusions The tumor size,bile duct dilatation,lymph node metastasis,pancreatic parenchyma atrophy and vascular involvement evaluated by MDCT had a certain value in differentiating PACC from PDAC,and the tumor size,lymph node metastasis and pancreatic parenchyma atrophy were independent predictors for the diagnosis of PACC.