腹部神经内分泌肿瘤CT表现与病理对照分析

发布时间：2018-03-23 08:24

本文选题：胃肠道　切入点：神经内分泌肿瘤　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分胃肠道神经内分泌肿瘤CT表现与病理分级对照分析目的:探讨胃肠道神经内分泌肿瘤CT表现与病理学分级的相关性。方法:选取我院收治的27例胃肠道神经内分泌肿瘤患者为研究资料,所有患者术前均行CT平扫及增强检查,并经手术病理学证实。对所有患者的一般资料、影像学特征及其与病理学分级的对照关系进行回顾性分析。参照2010年WHO对神经内分泌肿瘤分类标准,分为神经内分泌瘤(Neuroendocrine tumor,NET)G1、G2和神经内分泌癌(Neuroendocrine carcinoma,NEC)G3两组。结果:由于本研究收集病例数较少,故分为两组神经内分泌肿瘤(NET)和神经内分泌癌(NEC)进行研究。27例胃肠道神经内分泌肿瘤患者中,NET(G1+G2)患者16例,男11例,患者的平均年龄为(54.62±2.66)岁;NEC(G3)患者共11例,男7例,患者的平均年龄为(54.24±2.33)岁。不同级别胃肠道内分泌肿瘤在性别、年龄、肿瘤大小、边界、生长方式、坏死囊变、网膜种植转移方面,差异无统计学意义(P0.05)。NEC组生长方式主要为透壁性,坏死囊变多见,大部分病变伴有邻近组织的侵犯,常有淋巴结及远处转移;两组病变在透壁性生长、淋巴转移、邻近组织侵犯及远处转移方面,差异有统计学意义(P0.05)。增强后,NEC组肿瘤多为明显不均匀强化,然而不同级别内分泌肿瘤的强化程度及方式差异均无统计学意义(P0.05),但经计算分析各期扫描病灶的绝对强化程度以及病灶与肝脏静脉期CT值差的差异有统计学差异(P0.05)。结论:CT在胃肠道神经内分泌肿瘤病理分级方面有较大价值,通过对透壁性生长、远处淋巴结转移、邻近器官侵犯、远处转移等CT征象进行观察,以及强化程度的定量指标的测量存在统计学意义,并且A及△A敏感度及特异性更高,具有更好的检验效能。CT检查有助于对胃肠道神经内分泌肿瘤分化程度进行评估,以指导临床手术方案的制定。第二部分胰腺神经内分泌肿瘤CT表现与病理分级对照分析目的:探讨胰腺神经内分泌肿瘤CT表现与病理学分级的相关性。方法:选取我院收治的41例胰腺神经内分泌肿瘤患者为研究资料,所有患者术前均行CT平扫、增强检查,并经手术病理学证实。对所有患者的一般资料、影像学特征及其与病理学分级的对照关系进行回顾性分析。参照2010年WHO病理组织学关于胰腺神经内分泌肿瘤分类系统,根据Ki-67和核分裂数,把胰腺神经内分泌肿瘤分为三个等级:G1、G2和G3。结果:41例胰腺神经内分泌肿瘤患者中,G1、G2、G3组患者分别为17例、13例、11例,其中男性25例,平均年龄为(45.78±3.55)岁;不同级别肿瘤性别、年龄、肿瘤位置、大小、生长方式、形态和有无钙化、囊变坏死、内分泌功能无统计学差异(P0.05);坏死囊变由于肿瘤体积较大,缺血所致;钙化主要是因为营养不良,这两种征象均与肿瘤大小及血供有关,并不能准确发映出肿瘤的病理类型。CT增强后,不同级别肿瘤在各期扫描中的绝对强化程度、病灶与肝脏静脉期CT值差有统计学差异(P0.05);虽然AP、VP、BP的计算在理论上消除了对比剂注射速度及CT扫描时间的影响,但经数据分析三者并无统计学意义(P0.05)。结论:不同级别胰腺神经内分泌肿瘤在临床特征及CT征象无统计学差异。不同级别肿瘤增强扫描动脉期及平衡期的绝对强化程度以及其与肝脏静脉期CT差值有统计学差异,并且A及△A敏感度及特异性更高,具有更好的检验效能。所以,CT检查对胰腺神经内分泌肿瘤的诊断有较高价值,有助于评估胰腺神经内分泌肿瘤的病理分级。
[Abstract]:The first part of gastrointestinal neuroendocrine tumor expression of CT and pathological grading control analysis objective: To investigate the correlation between pathological classification of gastrointestinal neuroendocrine tumors CT and pathology. Methods: 27 cases of gastrointestinal neuroendocrine tumor patients in our hospital as the research data, all patients underwent preoperative CT scan and enhanced scan. By surgery and pathology. The general data of all patients were retrospectively analyzed, comparison between the imaging features and pathological classification. According to the standard of WHO in 2010 to neuroendocrine tumor classification, divided into tumor secrete nerve (Neuroendocrine tumor, NET) in G1, G2 and neuroendocrine carcinoma (Neuroendocrine carcinoma, NEC G3) two groups. Results: the study collected a small number of cases, it is divided into two groups of neuroendocrine tumors (NET) and neuroendocrine carcinoma (NEC) of.27 patients with gastrointestinal neuroendocrine In cancer patients, NET (G1+G2) 16 cases, 11 cases were male, the average age of the patients was (54.62 + 2.66); NEC (G3) in patients with a total of 11 cases, 7 cases were male, the average age of the patients was (54.24 + 2.33) years old. Gastrointestinal endocrine tumors at different levels of gender, age, tumor size, boundary, growth pattern, cystic and necrotic omental metastasis, there was no statistically significant difference (P0.05) growth of.NEC group was mainly transmural necrosis, cystic, invaded most of lesions with adjacent tissue, often with lymph node and distant metastasis; two lesions in transmural group growth, lymph node metastasis, adjacent tissue invasion and distant metastasis, the difference was statistically significant (P0.05). After enhancement, the tumor of NEC group were obviously heterogeneous enhancement, but the differences were not statistically significant enhancement degree and different levels of endocrine tumors (P0.05), but the calculation analysis of the absolute phase scan lesions The degree of enhancement and disease and hepatic venous phase CT value difference was statistically difference (P0.05). Conclusion: CT has great value in gastrointestinal neuroendocrine tumor pathological grade, through the growth of transmural, distant lymph node metastasis, distant metastasis and invasion of neighboring organs, CT signs were observed, and strengthen the quantitative measurement the degree has statistical significance, and the A and A sensitivity and higher specificity and effectiveness of.CT examination has better contribute to gastrointestinal neuroendocrine tumor differentiation was assessed in order to develop guiding clinical surgery scheme. The second part of pancreatic neuroendocrine tumors CT appearance and pathological grade were analyzed objective: To investigate the correlation between pathological classification of pancreatic neuroendocrine tumors CT and pathology. Methods: 41 cases of pancreatic neuroendocrine tumor patients in our hospital as the research data, the The patient underwent preoperative CT scan, enhanced scan, and confirmed by surgery and pathology. The general data of all patients were retrospectively analyzed, comparison between the imaging features and pathological grading. In reference to the 2010 WHO on histopathology of pancreatic neuroendocrine tumor classification system based on Ki-67 and mitotic count, the pancreas neuroendocrine tumors are divided into three levels: G1, G2 and G3. results: 41 cases of patients with pancreatic neuroendocrine tumors, G1, G2, G3 groups were 17 cases, 13 cases, 11 cases, including 25 cases of male, mean age (45.78 + 3.55) years; different levels of tumor sex, age tumor location, size, growth, morphology and calcification, cystic necrosis, no significant difference in endocrine function (P0.05); cystic necrosis due to the tumor volume is larger, mainly because of calcification caused by ischemia; malnutrition, these two features are correlated with tumor size and blood For, and can not accurately reflect the pathological type of.CT tumor after enhancement, different levels of tumor in different stages of scanning in the absolute degree of enhancement, the lesions and hepatic venous phase CT value difference was statistically different (P0.05); while AP, VP, BP calculation to eliminate the effect of contrast agent injection speed and CT scanning time in theory, but through the data analysis of three was not statistically significant (P0.05). Conclusion: there was no significant difference in different levels of pancreatic neuroendocrine tumors in clinical characteristics and CT features of different levels. The absolute strong degree of tumor enhancement on arterial phase scanning and equilibrium phase as well as the hepatic venous phase difference had statistical difference between CT and A. A and the sensitivity and specificity of higher testing efficiency is better. Therefore, a higher value of CT examination in the diagnosis of pancreatic neuroendocrine tumors, pathological classification is helpful to evaluate pancreatic neuroendocrine tumors.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735;R730.44

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