胰腺神经内分泌肿瘤的多层螺旋CT表现及与不同病理分级的相关性

摘要

目的 探讨胰腺神经内分泌肿瘤(pNET)的多层螺旋CT (MSCT)表现及与不同病理分级的相关性,以提高本病的诊断准确率.资料与方法 回顾性分析35例经手术病理证实的pNET的MSCT表现.所有患者均行CT平扫及三期增强检查,分析病变的影像学特征及各期强化参数.结果 35例pNET中,G1级15例,G2级15例,G3级5例.不同病理级别pNET患者的年龄、性别及内分泌功能差异无统计学意义(P＞0.05).G1、G2、G3级中包膜完整病灶分别为11个、5个、0个,囊变坏死病灶分别为3个、9个、4个,伴恶性征象(周围侵犯或转移)分别为1个、1个、4个,不同病理级别pNET病灶的包膜完整性、囊变坏死及恶性征象的出现率差异均有统计学意义(P＜0.05);多元有序回归分析显示,仅周围侵犯及转移与病理级别相关(OR=0.09,95％ CI 0.01～0.86,P＜0.05).不同病理级别pNET病灶的三期绝对强化程度及强化百分比、动脉期及门静脉期病灶相对强化程度比较,差异均有统计学意义(P＜0.05).结论 不同病理级别pNET的MSCT表现具有一定的特征性,周围侵犯及转移与高级别pNET相关,CT检查有助于术前的病理分级诊断.%Purpose To explore the correlation between multi-slice spiral CT (MSCT) findings of pancreatic neuroendocrine tumor (pNET) and different histological grades,so as to improve the diagnostic accuracy.Materials and Methods MSCT data of 35 pathologically confirmed pNET were retrospectively analyzed.All patients underwent CT plain scan and three-phased contrast-enhanced CT scan.The imaging features and the enhanced parameters in each stage were analyzed.Results Among the 35 pNET,there were 15 G 1,15 G2 and 5 G3.There was no statistically significant difference in age,gender and endocrine function among different grades (P＞0.05).The number of lesions with intact capsule in G1,G2 and G3 was 11,5 and 0,respectively;the number of lesions with cystic change or necrosis was 3,9,and 4,respectively;and the number of lesions with sign of malignancy (locally invasion or metastasis) was 1,1 and 4,respectively.The differences in completeness of capsule,cystic change or necrosis and sign of malignancy among different grades were all statistically significant (P＜0.05).Multivariate analysis suggested that only peripancreatic tissue invasion or metastasis was significantly associated with pathological classification (OR=0.09,95％ CI 0.01-0.86,P＜0.05).The three-stage absolute enhanced degree and the enhanced percentage of pNET in different grades,as well as the relative enhanced degree between lesions in arterial phase and portal venous phase were all statistically significantly different (P＜0.05).Conclusion The MSCT findings of pNET with different pathological grades have certain characteristic.Peripancreatic tissue invasion or metastasis is associated with high-grade tumors,and CT features of different grades can contribute to the preoperative grading of pancreatic neuroendocrine tumors.