胰腺伴破骨细胞样巨细胞未分化癌的影像学特征分析

Analysis of imaging characteristics of undifferentiated carcinoma with pancreatic osteoclast-like giant cell

目的探讨胰腺伴破骨细胞样巨细胞未分化癌(UPC-OGC)的计算机断层扫描(CT)和磁共振成像(MRI)特征。方法回顾性纳入2015年4月至2019年11月在复旦大学附属中山医院经病理确诊为UPC-OGC、术前行上腹部CT或MRI检查且临床和病理资料完整的11例患者。分析所有UPC-OGC患者的CT、MRI图像特征,包括病灶位置、数目、形态、大小、边界,平扫、强化特点,周围侵犯、转移情况等。采用独立样本t检验进行统计学分析。结果11例UPC-OGC患者的肿瘤病灶均为单发,病灶最大径(范围)为(4.84±2.96)cm(2.00~12.80 cm)。7例UPC-OGC患者肿瘤病灶位于胰头,2例位于胰体,1例位于胰尾,1例位于胰体尾部。3例UPC-OGC患者肿瘤病灶形态为类圆形,8例患者肿瘤病灶形态为椭圆形伴分叶。8例UPC-OGC患者肿瘤病灶边界清晰,3例患者肿瘤病灶边界不清。7例UPC-OGC患者行CT平扫和增强扫描检查,CT平扫检查示肿瘤实性区CT值与正常胰腺实质相近[(37.14±6.10)HU比(43.14±4.55)HU],差异无统计学意义(t=-2.85,P=0.097);CT动脉期增强扫描检查示肿瘤实性区强化程度低于正常胰腺实质[(67.29±12.79)HU比(90.43±9.81)HU],差异有统计学意义(t=-4.10,P=0.004);CT静脉期增强扫描检查示肿瘤病灶实性区持续强化,强化程度与正常胰腺实质相近[(84.71±15.30)HU比(79.57±10.73)HU],差异无统计学意义(t=0.38,P=0.535)。CT和MRI增强扫描检查均表现为病灶不均匀强化,动脉期病灶的实性成分强化稍低于正常胰腺实质,边缘和内部分隔渐进性强化,静脉期和平衡期强化程度稍高于正常胰腺实质或与正常胰腺相近。结论UPC-OGC的CT和MRI征象有一定特征性,有助于疾病的诊断和鉴别。

Objective To investigate the imaging characteristics of computed tomography(CT)and magnetic resonance imaging(MRI)of undifferentiated carcinoma with pancreatic osteoclast-like giant cell(UPC-OGC).Methods From April 2015 to November 2019,at Zhongshan Hospital,Fudan University,11 pathologically confirmed UPC-OGC patients who received upper abdominal CT or MRI before surgery and with complete clinical and pathological data were retrospectively included.The imaging characteristics of CT and MRI were analyzed,which included lesion location,number,shape,size,boundary,plain scan and enhancement features,adjacent tissue invasion and metastasis.Independent sample t test was used for statistical analysis.Results The tumor lesions of 11 patients with UPC-OGC were all single,and the maximum diameter of lesion was(4.84±2.96)cm(ranged from 2.00 to 12.80 cm).The lesions of 7 patients with UPC-OGC were located in the head of pancreas,2 located in the body of pancreas,1 located in the tail of pancreas and 1 located in the junction of body and tail of pancreas.The lesion shapes of 3 patients with UPC-OGC were round,and the lesion shapes of 8 patients were oval with lobulation.The lesion boundaries of 8 patients with UPC-OGC were clear and the lesion boundaries of 3 patients were unclear.Seven patients with UPC-OGC were examined by plain and enhanced CT scan.Plain CT scan showed that the density of solid area of the tumor was similar to that of normal pancreatic parenchyma((37.14±6.10)HU vs.(43.14±4.55)HU),and the difference was not significant(t=-2.85,P=0.097).Contrast-enhanced CT scan in arterial phase showed that the degree of enhancement in solid area of the tumor was weaker than that of normal pancreatic parenchyma((67.29±12.79)HU vs.(90.43±9.81)HU),and the difference was statistical significant(t=-4.10,P=0.004),while contrast-enhanced CT scan showed that in venous phase the solid area of the tumor continued to strengthen and the degree of enhancement was similar to that of normal pancreatic parenchyma((84.71±15.30)HU vs.(79.57±10.73)HU),and the difference was not significant(t=0.38,P=0.535).Both CT and MRI enhanced scans showed uneven enhancement of the lesions,the degree of enhancement of solid component in arterial phase was slightly weaker than that of normal pancreatic parenchyma and the marginal and internal separation were progressively enhanced,and the degree of enhancement in the venous phase and balanced phase was slightly higher than that of the normal pancreatic parenchyma or similar to that of the normal pancreas.Conclusions The imaging of CT and MRI of UPC-OGC have certain characteristics,which are helpful for the diagnosis and identification of the disease.