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CT征象对胰腺神经内分泌肿瘤侵袭性行为的预测价值

陈小勇 徐敬慈 李芹芹 潘自来

陈小勇, 徐敬慈, 李芹芹, 等. CT征象对胰腺神经内分泌肿瘤侵袭性行为的预测价值[J]. CT理论与应用研究, 2022, 31(3): 399-407. DOI: 10.15953/j.ctta.2021.082
引用本文: 陈小勇, 徐敬慈, 李芹芹, 等. CT征象对胰腺神经内分泌肿瘤侵袭性行为的预测价值[J]. CT理论与应用研究, 2022, 31(3): 399-407. DOI: 10.15953/j.ctta.2021.082
CHEN X Y, XU J C, LI Q Q, et al. The predictive value of CT findings in invasive behavior of pancreatic neuroendocrine tumors[J]. CT Theory and Applications, 2022, 31(3): 399-407. DOI: 10.15953/j.ctta.2021.082. (in Chinese)
Citation: CHEN X Y, XU J C, LI Q Q, et al. The predictive value of CT findings in invasive behavior of pancreatic neuroendocrine tumors[J]. CT Theory and Applications, 2022, 31(3): 399-407. DOI: 10.15953/j.ctta.2021.082. (in Chinese)

CT征象对胰腺神经内分泌肿瘤侵袭性行为的预测价值

doi: 10.15953/j.ctta.2021.082
详细信息
    作者简介:

    陈小勇:男,上海交通大学医学院附属瑞金医院放射科主治医师,主要从事CT、MRI影像诊断,E-mail:cxy831117@163.com

    潘自来:男,上海交通大学医学院附属瑞金医院放射科主任医师、硕士生导师,主要研究方向为胃癌影像学、胸部影像学,E-mail:zilaipanlilly@163.com

  • 中图分类号: R  814

The Predictive Value of CT Findings in Invasive Behavior of Pancreatic Neuroendocrine Tumors

  • 摘要: 目的:探讨胰腺神经内分泌肿瘤(pNET)的CT征象对其侵袭性行为的预测价值。方法:回顾性分析经手术病理确诊、临床及CT资料完整、术前均行胰腺CT平扫及增强检查的120例pNET,分析病灶的部位、形态、包膜、有无囊变和钙化、有无胰管扩张、肿瘤的强化方式,测量肿瘤最大径、最短径以及实性部分平扫、动脉期及门脉期密度,并计算动脉期强化差值、门脉期强化差值。根据手术病理结果将肿瘤分为侵袭组和无侵袭组,比较两组间CT征象的差异。使用绘制受试者操作特征(ROC)曲线评价肿瘤最大径、最短径、动脉期差值和门脉期差值对pNET的侵袭性行为的预测价值。结果:侵袭组和无侵袭组pNET在发病部位、胰管扩张、囊变、钙化及强化方式无差异,在形态、完整包膜上有差异。两组在最大径、最短径、动脉期强化差值、门脉期强化差值定量特征有差异,其ROC曲线下面积为0.693、0.69、0.73和0.64,具有判别效能。对6个差异有统计学意义的影像特征通过多变量Logistic回归分析,结果显示动脉期强化差值为判断pNET侵袭性行为的独立预测因素,动脉期强化差值最佳临界点为90.1 HU(灵敏度0.714,特异性0.656,阳性预测值64.5%,阴性预测值72.4%,准确率68.3%)。结论:胰腺神经内分泌肿瘤体积大、形态不规则、包膜不完整或无包膜,肿瘤实性成分动脉期、门脉期强化差值低等征象提示肿瘤具有侵袭性行为,其中动脉期强化差值为pNET侵袭性行为的独立预测因素。

     

  • 图  1  女,75岁,非侵袭性胰腺神经内分泌肿瘤

    (a)为CT平扫,示胰头部见一类椭圆形稍低密度灶,密度均匀,边界清。(b)为增强扫描动脉期,示病灶重度强化,强化程度明显高于周围胰腺组织,病灶与胰腺交界面见肿瘤包膜。(c)为增强扫描门脉期,示病灶强化程度不均匀减低,实性部分密度仍高于胰腺组织,分界清,病灶为实性,无囊变坏死。(d)为病理图片,示肿瘤组织呈膨胀性生长,与胰腺组织分界清晰,肿瘤细胞呈器官样排列,细胞形态、大小较一致(HE染色×100)。

    Figure  1.  Female, 75 years old with a non-invasive pancreatic neuroendocrine tumor

    图  2  女,55岁,侵袭性胰腺神经内分泌肿瘤

    (a)为CT平扫,示胰尾部见一巨大不规则等密度肿块,密度不均匀,内可见条片低密度影,边界不清。(b)为增强扫描动脉期,示病灶中度不均匀强化,病灶与胰腺交界面未见肿瘤包膜,与周围血管、结肠壁、胃壁分界不清。(c)为增强扫描门静脉期,示病灶实性持续渐进性强化,内见囊变坏死不强化影,病灶以实性成分为主。(d)为病理图片,示肿瘤组织呈浸润性生长,侵犯胰腺周围纤维脂肪组织;肿瘤细胞呈片状排列,细胞大小不一致,部分细胞异型明显,核仁可见(HE染色×100)。

    Figure  2.  Female, 55 years old with a invasive pancreatic neuroendocrine tumor

    图  3  肿瘤最大径、最短径预测pNET侵袭性行为的受试者操作特征(ROC)曲线

    Figure  3.  ROC curves of maximum and minimum tumor diameters to predict invasive behavior of pNET

    图  4  肿瘤实性成分的动脉期强化差值、门静脉期强化差值程度预测pNET侵袭性行为的受试者操作特征(ROC)曲线

    Figure  4.  ROC curves for predicting invasive behavior of pNET by arterial enhancement difference and portal enhancement difference of tumor solid component

    图  5  对6个有统计学意义的影像特征的多变量Logistic回归分析

    Figure  5.  Multivariate Logistic regression analysis of six statistically significant image features

    表  1  侵袭组与无侵袭组pNET的临床特征比较

    Table  1.   Comparison of clinical characteristics of pNET between the invasive group and the non-invasive group

    组别例数年龄/岁性别/例临床症状
    /例
    基础疾病/例血清神经元特
    异性烯醇化酶
    /(ng/mL)
    分泌功能
    /例
    病理分级
    /例
    1种≥2种G1G2G3
    侵袭组6453.72±12.89333131334317418.93±6.823133203410
    无侵袭组5651.95±14.972531342244 8430.53±51.1338183818 0
    统计量0.485a0.573b1.813b2.730b-1.1234.609b20.065b
    P0.487 0.470 0.202 0.255 0.2610.042 <0.001
     注:a:t值;b:χ2值。
    下载: 导出CSV

    表  2  侵袭组与无侵袭组pNET的CT影像学特征比较结果(例)

    Table  2.   Comparison of CT imaging features of pNET between the invasive group and the non-invasive group (cases)

    组别例数位置形态包膜胰管扩张囊变钙化强化方式
    头颈部体部尾部规则不规则完整不完整
    或无
    均匀不均匀
    侵袭组 64271225273722422143224215492440
    无侵袭组5625151647 949 713431541 8482531
    统计值 1.861 22.013 34.8891.3550.8071.6150.933
    P0.394<0.001<0.0010.3110.4300.2490.354
    下载: 导出CSV

    表  3  侵袭组与无侵袭组pNET的CT影像学特征比较结果

    Table  3.   Comparison of CT imaging features of pNET between the invasive group and the non-invasive group

    组别例数最大径/cm最短径/cm肿瘤实性成分强化差值/HU
    动脉期差值门脉期差值
    侵袭组 644.051±2.9203.062±2.051 80.933±48.28173.801±28.912
    无侵袭组562.511±1.5422.084±1.220112.912±61.95389.882±39.901
    统计检验统计值12.5189.90510.0716.501
    P 0.0010.002 0.0020.012
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-12-25
  • 录用日期:  2022-03-04
  • 网络出版日期:  2022-03-15
  • 刊出日期:  2022-05-23

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