MDCT在鉴别胰腺实性型浆液性囊腺瘤与富血供神经内分泌肿瘤中的价值

MDCT in Differentiation of Solid Serous Cystadenoma and Hypervascular Neuroendocrine Tumor of the Pancreas

目的:探讨多排CT(MDCT)在鉴别胰腺实性型浆液性囊腺瘤(sSCA)与富血供神经内分泌肿瘤(pNET)中的价值。方法:回顾性分析2014年1月至2020年2月经上海交通大学医学院附属瑞金医院手术病理证实为胰腺sSCA(13例)及pNET(26例)的临床、上腹部CT资料。采用χ2检验比较2组患者定性参数(性别、病灶部位、形态等),采用两独立样本t检验比较2组患者定量参数(病灶大小、平扫CT值、动脉期CT值等),对其中差异有统计学意义的定量参数绘制ROC曲线并比较曲线下面积(AUC)以评价其诊断效能。结果:sSCA(12/13)相较于pNET(13/26)平扫多呈相对低密度改变,sSCA平扫、门脉期CT值[(29.4±3.7)HU、(107.3±13.1)HU)]低于pNET[(43.6±6.5)HU、(123.4±18.4)HU],而动脉期、门脉期强化率[(4.1±1.3)×100%、(2.8±0.8)×100%]均高于pNET[(2.9±0.9)×100%、(1.9±0.5)×100%],差异均有统计学意义(P<0.05)。ROC曲线显示平扫CT值所对应AUC(0.959)高于增强动脉期强化率(0.781)、门脉期CT值(0.750)、门脉期强化率(0.831),差异有统计学意义(P<0.05),平扫CT值≤36.8 HU诊断sSCA的灵敏度、特异度分别为100%、92.3%。结论:胰腺sSCA与富血供pNET的CT表现常易混淆,平扫CT值对两者鉴别诊断具有较大价值。

Purpose:To investigate the value of multi-detector computed tomography(MDCT)in differential diagnosis between pancreatic solid serous cystadenoma(sSCA)and hypervascular pancreatic neuroendocrine tumor(pNET).Methods:Between January 2014 and February 2020,13 sSCA and 26 pNET surgically resected in our institute underwent dual-phase CT imaging preoperatively.Non-quantitative values(gender,tumor location,shape,etc.)were analyzed with Chi-square test.Quantitative values(tumor diameter,CT value on unenhanced phase and arterial phase,etc.)were analyzed with independent samples t test.Results were also subjected to receiver operating characteristic(ROC)analysis.Results:sSCA(12/13)tended to be more frequently hypodense on unenhanced CT images than pNET(13/26).CT values on unenhanced phase and portal venous phase were significantly lower in sSCA(29.4 HU±3.7 HU,107.3 HU±13.1 HU)than pNET(43.6 HU±6.5 HU,123.4 HU±18.4 HU),while the enhancement ratio on arterial phase and portal venous phase were significantly higher in sSCA[(4.1±1.3)×100%,(2.8±0.8)×100%]than pNET[(2.9±0.9)×100%,(1.9±0.5)×100%](P<0.05).The area under the ROC curve for unenhanced CT attenuation values(0.959)was significantly greater than the area for CT attenuation values on portal venous phase(0.750),enhancement ratio on arterial phase(0.781)and portal venous phase(0.831)(P<0.05).A threshold unenhanced CT attenuation value of 36.8 HU had a sensitivity-to-specificity ratio of 100%:92.3%for characterizing sSCA.Conclusion:sSCA and hypervascular pNET share similar CT manifestation.Unenhanced CT attenuation value shows a high diagnostic accuracy in the differentiation of sSCA from pNET.