胃十二指肠异位胰腺与小于3 cm胃肠道间质瘤的多排螺旋CT特征比较

Comparison of mutidetector CT features between gastroduodenal heterotopic pancreas and gastrointestinal stromal tumors smaller than 3 cm in diameter

目的比较胃十二指肠异位胰腺(HP)与直径<3 cm胃肠道间质瘤(GIST)的临床及多排螺旋CT(MDCT)影像特征。方法收集大坪医院2012年5月-2021年5月收治并经病理证实的胃十二指肠HP 28例和直径<3 cm GIST 33例,回顾性分析、比较其临床与MDCT特征,包括病变位置、生长方式、形态、轮廓、大小及MDCT多期增强表现等;寻找两者间差异显著的特征作为鉴别诊断的指标,采用ROC曲线评价各指标的诊断效能。结果胃十二指肠HP与GIST患者的性别、体重指数(BMI)、临床症状及体征比较差异无统计学意义(P>0.05)。两组患者的年龄、病变MDCT形态学特征(位置、生长方式、分叶征)及CT值(平扫CT值、门静脉期CT值及强化值)比较,差异有统计学意义(P<0.05,P<0.01);其中年龄、位置、门静脉期CT值鉴别效能较好,ROC曲线下面积(AUC)均>0.7。当3个MDCT形态学特征(位置、生长方式、分叶征)联合使用时,AUC可提高至0.954(95%CI 0.867~0.991)。平扫CT值、门静脉期CT值及强化值均可用于鉴别HP与GIST,以门静脉期CT值效能最好。年龄、平扫CT值、门静脉期CT值及强化值的最佳阈值分别为50岁、40.33 HU、72.53 HU及37.33 HU,可作为鉴别HP及GIST的参考值。结论通过综合分析患者年龄、MDCT病变形态学特征及多期增强定量指标,可对胃十二指肠HP与<3 cm GIST作出初步鉴别诊断。

Objective To compare the clinical and multidetector computed tomography(MDCT)features of gastroduodenal heterotopic pancreas(HP)and gastrointestinal stromal tumors(GIST)smaller than 3 cm in diameter.Methods A total of 61 patients pathologically confirmed as gastroduodenal HP(n=28)and GIST(diameter<3 cm,n=33)in Daping Hospital during 2012-2021 were included.Their clinical and MDCT features(including lesion location,growth mode,morphology,contour,size and MDCT multi-phase enhancements)were retrospectively reviewed and compared.The characteristics with significant difference between the two were searched as the index of differential diagnosis,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficiency of each parameter.Results No significant difference existed in gender,body mass index(BMI),clinical symptoms and signs between the patients with gastroduodenal HP and GIST(P>0.05),while statistically significant differences existed in age,MDCT morphological features(location,growth pattern,lobulation sign)and CT values(plain CT value,portal venous phase CT value and enhancement value)between the two groups(P<0.05,P<0.01).Among them,age,location,and portal venous phase CT value had better efficiency,and the areas under ROC curves(AUC)were all greater than 0.700.When the 3 MDCT morphological features(location,growth pattern,lobulation sign)were combined in use,the AUC was improved to 0.954(95%CI 0.867-0.991).The plain scan CT value,portal venous phase CT value and enhancement value can be separately used to distinguish HP and GIST respectively,and the portal venous phase CT value has the best efficiency.The optimal cut-offs of age,plain scan CT value,portal venous phase CT value and enhancement value were 50 years,40.33 HU,72.53 HU and 37.33 HU,respectively,which could be used as reference indicators to differentiate HP from GIST.Conclusion By comprehensively analyze the patient's age,lesion MDCT morphological features and multi-phase enhanced quantitative parameters,a preliminary differential diagnosis can be made between gastroduodenal HP and GIST smaller than 3 cm in diameter.