中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2014年
9期
682-687
,共6页
王大丽%周健%郑双丽%夏建余%胡红杰
王大麗%週健%鄭雙麗%夏建餘%鬍紅傑
왕대려%주건%정쌍려%하건여%호홍걸
胰腺肿瘤%导管内乳头状黏液性肿瘤%计算机体层摄影%磁共振成像
胰腺腫瘤%導管內乳頭狀黏液性腫瘤%計算機體層攝影%磁共振成像
이선종류%도관내유두상점액성종류%계산궤체층섭영%자공진성상
Pancreatic neoplasms%Intraductal papillary mucinous neoplasm%Tomography,X-Ray computed%Magnetic resonance imaging
目的 分析CT和MRI影像学检查在预测胰腺导管内乳头状黏液性肿瘤(IPMN)相关性浸润癌中的临床应用价值.方法 回顾性分析27例手术切除并经病理证实的IPMN患者的术前CT和MRI资料,其中7例患者术前同时进行了CT和MRI检查,9例患者仅进行了CT检查,11例患者仅进行了MRI检查.分析影像学上病变位置、导管累及类型、病变形态、病变最大径、主胰管扩张程度、胆总管扩张程度与IPMN相关性浸润癌发生的关系,探讨各种影像学征象在预测IPMN相关性浸润癌中的临床应用价值.结果 在27例IPMN中,病理证实19例患者存在IPMN相关性浸润性癌,2例具有IPMN相关性原位癌.导管累及类型(P =0.038)、病变形态(P =0.003)、胆总管扩张(P =0.004)与IPMN相关性浸润癌的发生有关.囊实性肿块预测浸润性IPMN的敏感性和特异性分别为66.7％ (8/12)和100.0％(8/8),胆总管扩张预测浸润性IPMN的敏感性和特异性分别为47.4％(9/19)和100.0％(8/8).病变位置与IPMN相关性浸润癌的发生无关(P =0.759).伴有浸润性癌的IPMN患者的主胰管最大径为(8.07 ±2.23) mm,明显大于不伴有浸润性癌的IPMN患者[(4.86±1.86) mm,P=0.002].主胰管最大径≥4 mm预测浸润性IPMN的敏感性和特异性分别为94.7％(18/19)和37.5％(3/8).对于分支型和混合型IPMN患者,伴有浸润性癌的病变最大径为(41.35±12.58) mm,明显大于不伴有浸润性癌的病变最大径[(23.76±8.06)mm,P=0.003].病变最大径≥40 mm预测浸润性IPMN的敏感性和特异性分别为50.0％(6/12)和87.5％(7/8).结论 影像学征象有助于预测IPMN相关性浸润性癌,对于指导治疗、制订手术方案和预测患者的预后有重要的临床价值.
目的 分析CT和MRI影像學檢查在預測胰腺導管內乳頭狀黏液性腫瘤(IPMN)相關性浸潤癌中的臨床應用價值.方法 迴顧性分析27例手術切除併經病理證實的IPMN患者的術前CT和MRI資料,其中7例患者術前同時進行瞭CT和MRI檢查,9例患者僅進行瞭CT檢查,11例患者僅進行瞭MRI檢查.分析影像學上病變位置、導管纍及類型、病變形態、病變最大徑、主胰管擴張程度、膽總管擴張程度與IPMN相關性浸潤癌髮生的關繫,探討各種影像學徵象在預測IPMN相關性浸潤癌中的臨床應用價值.結果 在27例IPMN中,病理證實19例患者存在IPMN相關性浸潤性癌,2例具有IPMN相關性原位癌.導管纍及類型(P =0.038)、病變形態(P =0.003)、膽總管擴張(P =0.004)與IPMN相關性浸潤癌的髮生有關.囊實性腫塊預測浸潤性IPMN的敏感性和特異性分彆為66.7％ (8/12)和100.0％(8/8),膽總管擴張預測浸潤性IPMN的敏感性和特異性分彆為47.4％(9/19)和100.0％(8/8).病變位置與IPMN相關性浸潤癌的髮生無關(P =0.759).伴有浸潤性癌的IPMN患者的主胰管最大徑為(8.07 ±2.23) mm,明顯大于不伴有浸潤性癌的IPMN患者[(4.86±1.86) mm,P=0.002].主胰管最大徑≥4 mm預測浸潤性IPMN的敏感性和特異性分彆為94.7％(18/19)和37.5％(3/8).對于分支型和混閤型IPMN患者,伴有浸潤性癌的病變最大徑為(41.35±12.58) mm,明顯大于不伴有浸潤性癌的病變最大徑[(23.76±8.06)mm,P=0.003].病變最大徑≥40 mm預測浸潤性IPMN的敏感性和特異性分彆為50.0％(6/12)和87.5％(7/8).結論 影像學徵象有助于預測IPMN相關性浸潤性癌,對于指導治療、製訂手術方案和預測患者的預後有重要的臨床價值.
목적 분석CT화MRI영상학검사재예측이선도관내유두상점액성종류(IPMN)상관성침윤암중적림상응용개치.방법 회고성분석27례수술절제병경병리증실적IPMN환자적술전CT화MRI자료,기중7례환자술전동시진행료CT화MRI검사,9례환자부진행료CT검사,11례환자부진행료MRI검사.분석영상학상병변위치、도관루급류형、병변형태、병변최대경、주이관확장정도、담총관확장정도여IPMN상관성침윤암발생적관계,탐토각충영상학정상재예측IPMN상관성침윤암중적림상응용개치.결과 재27례IPMN중,병리증실19례환자존재IPMN상관성침윤성암,2례구유IPMN상관성원위암.도관루급류형(P =0.038)、병변형태(P =0.003)、담총관확장(P =0.004)여IPMN상관성침윤암적발생유관.낭실성종괴예측침윤성IPMN적민감성화특이성분별위66.7％ (8/12)화100.0％(8/8),담총관확장예측침윤성IPMN적민감성화특이성분별위47.4％(9/19)화100.0％(8/8).병변위치여IPMN상관성침윤암적발생무관(P =0.759).반유침윤성암적IPMN환자적주이관최대경위(8.07 ±2.23) mm,명현대우불반유침윤성암적IPMN환자[(4.86±1.86) mm,P=0.002].주이관최대경≥4 mm예측침윤성IPMN적민감성화특이성분별위94.7％(18/19)화37.5％(3/8).대우분지형화혼합형IPMN환자,반유침윤성암적병변최대경위(41.35±12.58) mm,명현대우불반유침윤성암적병변최대경[(23.76±8.06)mm,P=0.003].병변최대경≥40 mm예측침윤성IPMN적민감성화특이성분별위50.0％(6/12)화87.5％(7/8).결론 영상학정상유조우예측IPMN상관성침윤성암,대우지도치료、제정수술방안화예측환자적예후유중요적림상개치.
Objective The purpose of our study was to evaluate the predictive factors of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT and MRI.Methods Preoperative MDCT or/and MRI of 27 consecutive patients (19 men,8 women,mean age 61.3 years) who had undergone surgical resection and had a pathological diagnosis of IPMN were retrospectively assessed.The type of ductal involvement,solid appearance of the lesion,location,tumor size of branch duct type and combined type lesions,maximum diameter of the tumor,caliber of the main pancreatic duct and the extent of the common bile duct dilatation were assessed on CT and MRI and correlated with the pathological findings of the invasive carcinoma.Two abdominal radiologists reviewed all the images,and when discrepancies of the findings were found,the consensus was reached by discussion.Results Pathological analysis revealed carcinoma in situ in two patients and invasive carcinoma in 19 patients arising from the IPMN.The type of ductal involvement (P =0.038),a solid mass (P =0.003) and the common bile duct dilatation (≥ 15 mm,P =0.004) were correlated with the presence of associated invasive carcinoma.For the finding of solid and cystic mass in predicting invasive IPMN,the sensitivity was 66.7％(8/12) and specificity was 100.0％ (8/8),and for bile duct diameter ≥15 mm,the sensitivity was 47.4％ (9/19) and specificity was 100.0％ (8/8).However,no association was found between the location of the lesion and associated invasive carcinoma.The caliber of the main pancreatic duct of patients with associated invasive carcinoma was significantly larger than that in the cases without invasive carcinoma (8.07 ± 2.23 mm vs.4.86 ± 1.86 mm,P =0.002).When using the main pancreatic duct dilatation ≥ 4 mm as the threshold,the sensitivity and specificity in predicting invasive IPMN were 94.7％ (18/19) and 37.5％ (3/8),respectively.For the branch duct type and combined type,the size of the tumor with associated invasive carcinoma was significantly larger than these without invasive carcinoma (41.35 μ 12.58) mm vs.(23.76 μ 8.06) mm (P =0.003).When the maximum diameter was ≥ 40 mm,the sensitivity and specificity in predicting invasive IPMN were 50.0％ (6/12) and 87.5％ (7/8),respectively.Conclusions The findings of CT and MRI are helpful to predict invasive carcinoma associated with IPMN,which may play an important role in the preoperative evaluation,surgical planning and predicting the prognosis of IPMN.
