CAJ | 학술논문

目的分析胰腺神经内分泌肿瘤(PNETs)的良恶性CT征象,提高对该病的定性诊断水平.方法回顾性分析96例经病理证实的PNETs患者临床资料及CT图像,分析肿瘤的大小、形态、位置、内部结构、钙化、分隔、胰胆管扩张及CT值.结果依据病理诊断标准,96例患者中良性40例,共41枚病灶,恶性56例,共59枚病灶.恶性组瘤体直径显著大于良性组(中位直径6.0 cm比2.2 cm),瘤块形态多不规则,以囊实性为主,可出现斑点状、弧线状、团块状钙化,胰胆管轻中度均匀扩张,两组差异均有统计学意义(P值均＜0.05),而肿瘤部位、瘤内有无分隔的差异无统计学意义.45.76％ (27/59)的恶性肿瘤在动脉期达到强化峰值,44.07％ (26/59)在静脉期达到强化峰值;68.29％ (28/41)良性肿瘤在动脉期达到强化峰值,31.71％(13/41)在静脉期达到强化峰值.恶性组在CT平扫及增强动脉期、静脉期、平衡期的CT值分别为(39.02±7.53)、(121.20±54.73)、(125.25 ±40.77)、(101.41 ±28.68) Hu;良性组分别为(41.49±8.59)、(144.73±53.95)、(157.05±44.72)、(121.02±29.80)Hu.恶性肿瘤在平扫时与良性肿瘤的CT值差异无统计学意义,而在增强期的CT值显著低于良性肿瘤,差异有统计学意义(P值均＜0.05).结论肿瘤最大径≥3.0 cm、形态不规则、有囊变坏死、钙化、胰胆管扩张等征象高度提示恶性,恶性肿瘤在增强扫描的动脉期、静脉期及平衡期的强化程度普遍低于良性肿瘤.
목적 분석이선신경내분비종류(PNETs)적량악성CT정상,제고대해병적정성진단수평.방법 회고성분석96례경병리증실적PNETs환자림상자료급CT도상,분석종류적대소、형태、위치、내부결구、개화、분격、이담관확장급CT치.결과 의거병리진단표준,96례환자중량성40례,공41매병조,악성56례,공59매병조.악성조류체직경현저대우량성조(중위직경6.0 cm비2.2 cm),류괴형태다불규칙,이낭실성위주,가출현반점상、호선상、단괴상개화,이담관경중도균균확장,량조차이균유통계학의의(P치균＜0.05),이종류부위、류내유무분격적차이무통계학의의.45.76％ (27/59)적악성종류재동맥기체도강화봉치,44.07％ (26/59)재정맥기체도강화봉치;68.29％ (28/41)량성종류재동맥기체도강화봉치,31.71％(13/41)재정맥기체도강화봉치.악성조재CT평소급증강동맥기、정맥기、평형기적CT치분별위(39.02±7.53)、(121.20±54.73)、(125.25 ±40.77)、(101.41 ±28.68) Hu;량성조분별위(41.49±8.59)、(144.73±53.95)、(157.05±44.72)、(121.02±29.80)Hu.악성종류재평소시여량성종류적CT치차이무통계학의의,이재증강기적CT치현저저우량성종류,차이유통계학의의(P치균＜0.05).결론 종류최대경≥3.0 cm、형태불규칙、유낭변배사、개화、이담관확장등정상고도제시악성,악성종류재증강소묘적동맥기、정맥기급평형기적강화정도보편저우량성종류.
Objective To explore the CT findings of benign and malignant pancreatic neuroendocrine tumors and improve its diagnostic accuracy.Methods The clinical information and enhanced CT findings of 96 cases with pathologically-proved pancreatic neuroendocrine tumors were retrospectively reviewed.The CT findings were evaluated by several factors,which included tumor size,morphology,location,internal composition,calcification,separation,bile duct and pancreatic duct dilation and CT value.Results All cases were divided into benign or malignant according to pathological grades,and benign group involved 40 cases with 41 lesions,while malignant group involved 56 cases with 59 lesions.The size of malignant lesions was significantly larger than that of benign lesions (median size 6.0 cm vs 2.2 cm),the shape of the lesions was irregular,and was mainly cystic solid,and mottling,curve shape,clumps calcification was present,then the bile duct and pancreatic duct was mild to moderately dilated,and the difference between the two groups was statistically significant (P ＜0.05).But the difference of tumor location,separation was not significant.45.76％ (27/59) of the malignant lesions reached the peak value in arterial phase,and 44.07％ (26/59) reached the peak value in venous phase;while 68.29％ (28/41) of the benign lesions reached the peak value in arterial phase,and 31.71％ (13/41) reached the peak value in venous phase.The CT values of malignant lesions in plain CT scanning,arterial phase,venous phase,balance phase were (39.02 ±7.53),(121.20 ± 54.73),(125.25 ± 40.77),(101.41 ± 28.68) Hu,while they were (41.49 ± 8.59),(144.73 ± 53.95),(157.05 ±44.72),(121.02 ±29.80) Hu in benign group.In plain CT scanning,the difference of CT value between malignant and benign lesions was not significant;but in the enhanced phase,the CT value of malignant lesions was significantly lower than that of benign lesions,and the difference was statistically significant (P ＜ 0.05).Conclusions The lesion with its size ≥ 3.0 cm,irregnlar morphology,cystic necrosis,calcification,pancreatic and bile duct dilatation is suggestive of malignancy tumor.The average CT values of malignant group are lower than those of the benign group in arterial,venous and balance phases.