多层螺旋CT鉴别诊断胰腺乏血供神经内分泌肿瘤与浆液性微囊腺瘤的临床价值

Clinical Value of Multi-slice Spiral CT in Differential Diagnosis of Pancreatic Neuroendocrine Tumor with Poor Blood Supply and Serous Microcystic Adenoma

目的 探讨多层螺旋CT鉴别诊断胰腺乏血供神经内分泌肿瘤与浆液性微囊腺瘤的临床价值。方法 回顾性分析19例胰腺乏血供神经内分泌肿瘤和17例浆液性微囊腺瘤患者的临床资料,均进行多层螺旋CT扫描,观察2组在病变部位、大小、边界、密度和强化峰值峰变化、CT值等影像学指标并进行比较,同时对重要CT影像进行敏感性、特异性分析。结果 (1)2组在边界、纤维间隔、强化峰值时间、转移或侵犯、浮云征方面的差异存在统计学意义(P<0.05)。2组在部位、形态、密度、胰管扩张、钙化上的差异无统计学意义(P>0.05)。(2)2组平扫期CT值比较差异不显著(P>0.05),而胰腺乏血供神经内分泌肿瘤组动脉期CT值明显高于浆液性微囊腺瘤组,门脉期CT值则显著低于浆液性微囊腺瘤组,比较差异有统计学意义(P<0.05)。结论 胰腺乏血供神经内分泌肿瘤CT界限不清,无纤维间隔,动脉期CT值高,有远处转移或侵犯,多数无浮云征;浆液性微囊腺瘤CT可见蜂窝状,瘤体中心有纤维瘢痕,轻中度强化。故螺旋CT可作为鉴别胰腺乏血供神经内分泌肿瘤与浆液性微囊腺瘤的重要影像学检查方法。

Objective To investigate the clinical value of multi-slice spiral CT in differential diagnosis of pancreatic neuroendocrine tumor with poor blood supply and serous microcystic adenoma.Methods 19 cases of pancreatic neuroendocrine tumor with poor blood supply and 17 cases of serous microcystic adenoma confirmed by pathology were retrospectively analyzed.All the patients were scanned with multi-slice spiral CT.The imaging indexes such as lesion location,size,boundary,density and enhancement peak,CT value were compared between the 2 groups,and the sensitivity and specificity of important CT images were analyzed.Results(1) there were significant differences in boundary,fiber interval,peak time of enhancement,metastasis or invasion,floating cloud sign between the 2 groups(P<0.05).The lesions of pancreatic neuroendocrine tumors with poor blood supply were mostly ill defined,without fibrous septum,with higher enhancement value in arterial phase,distant metastasis or invasion,and most of them had no floating cloud sign;while the lesions of serous microcystic adenoma were well defined,most of them had fibrous septum,with more obvious enhancement in venous phase,without metastasis or invasion,and most of them had floating cloud sign.There was no significant difference in location,shape,density,pancreatic duct dilatation and calcification between the 2 groups(P>0.05).(2) There was no significant difference in CT value between the two groups during plain scan(P>0.05),but the arterial phase CT value was significantly higher than that in the serous microcystic adenoma group,and the portal phase CT value was significantly lower than that in the serous microcystic adenoma group,the difference was statistically significant(P<0.05).Conclusion Distant metastasis or invasion,most of them without cloud sign.Spiral CT can be used as an important imaging examination to differentiate the 2 diseases.