胰腺神经内分泌肿瘤的CT表现与病理分级的相关性研究

发布时间：2018-05-26 06:14

  本文选题：pNENs + CT　； 参考：《济南大学》2017年硕士论文

【摘要】：目的:根据对pNENs的CT表现的分析,探讨其不同影像学特点与病理分级的相关性,评估其在临床诊断、治疗及预后方面的参考价值。方法:回顾性地研究经病理证明为pNENs的31例病人的影像及临床资料,查看并记下肿瘤的部位、大小、有无钙化、有无囊变坏死、有无淋巴结转移、有无远处器官转移、平扫及多期增强CT扫描数值,以及确定病理分级(包含Ki-67和每10个高倍视野中的核分裂象数目,二者病理分级结果出现差异时,以分级高者为准)。全部的观察结果均运用SPSS17.0版软件进行统计学分析:(1)首先分别把不同分级的平扫加三期增强的CT值用(均数±标准差)的方法来标示,以此对增强的类型进行总体的量化,研究不同分级的强化方式的不同;(2)比较各个指标的意义以及价值时,连续变量采用单因素方差分析,分类变量采用Kruskal-Walls检验。研究时首先在三组之间比较各个指标与病理分级的相关性,然后在组间两两比较比较上述指标与病理分级间的关系,从而分别筛选出有统计学意义的指标。最后用ROC曲线和“尤登指数”来计算有意义的研究因素的诊断有效率,其指标包含ROC曲线下面积、最佳阈值及其敏感性和特异性。结果:(1)通过对平扫及多期增强扫描的CT值(均数±标准差)比较分析,随病理分级的增加,总体的强化程度逐渐减弱;(2)经统计学分析,三组间有显著性差异的统计学指标分别为Ta(P=0.008)、Tv(P=0.012)、Tap(P=0.009)、Tvp(P=0.013)、Tav(P=0.024)、有无淋巴结转移(P=0.001)、长径是否大于3cm(P=0.032)、长径是否大于4cm(P=0.014)及CT值到达峰值的时间(P0.001);(3)经过组间的两两比较,可用于区分G1/2与G3的指标为Ta、Tv、Tap、Tvp及强化CT值到达峰值时间,可用于区分G1与G2的指标为病变长径的大小4MX≥3、MX≥4,另外Tav和Tvd还可用于区分G1与G3;(4)经过ROC曲线分析,有统计学意义意义的指标为4MX≥3(AUC=0.708,P=0.048)、MX≥4(AUC=0.744,P=0.021)、Ta(AUC=0.742,P=0.022)、Tav(AUC=0.727,P=0.031)。经过“尤登指数”分析,Ta的最佳临界值为107HU(sen=0.667、spe=0.812)、Tav为9HU((sen=0.667、spe=0.812)。结论:Ta、Tav、4MX≥3、MX≥4是对病理分级最为有效的指标,且AUC均大于0.70,有一定的诊断准确性,其中准确性最高的为MX≥4。此外,Ta的最佳阈值为107HU、Tav的最佳阈值为9HU,二者的敏感性和特异性相同,分别为0.667和0.821。因此我们可以认为Ta、Tav、4MX≥3、MX≥4对于判定肿瘤的分级、指导治疗以及预测预后具有一定的价值。其中强化方式主要区别低级别肿瘤(G1/2)与高级别肿瘤(G3),而大小是区别G1与G2的主要手段。但是这四个有意义指标的价值也有一定的限度,因此在判定肿瘤的分级时应该综合利用上述指标,提高诊断结果的正确性,为治疗的有效性提供一定的保证。
[Abstract]:Objective: to study the correlation between different imaging features and pathological grade of pNENs, and to evaluate its reference value in clinical diagnosis, treatment and prognosis. Methods: the imaging and clinical data of 31 patients with pNENs proved by pathology were studied retrospectively. The location, size, calcification, cystic necrosis, lymph node metastasis and distant organ metastasis were observed and recorded. The pathological grade (including Ki-67 and the number of mitotic images per 10 high-power field) was determined by plain scan and multi-phase enhanced CT scan. All the observation results were analyzed statistically by using SPSS17.0 software. (1) first of all, the CT values of different grades of plain scan plus phase 3 enhancement were marked by the method of (mean 卤standard deviation) respectively, so as to quantify the types of enhancement as a whole. To compare the significance and value of each index, single factor analysis of variance was used for continuous variables and Kruskal-Walls test was used for classifying variables. The correlation between each index and pathological grade was compared among the three groups, and then the relationship between the above indexes and the pathological grade was compared between the two groups. Finally, the diagnostic efficiency of meaningful research factors was calculated by using ROC curve and "Uden index", which included the area under the ROC curve, the optimum threshold, its sensitivity and specificity. Results by comparing and analyzing the CT value (mean 卤standard deviation) of plain scan and multiphase enhanced scan, the enhancement degree of the whole was gradually weakened with the increase of pathological grade. There were significant differences among the three groups. The statistical indexes of the three groups were as follows: (1) TapP0. 0012 (TapP0. 009), 0. 013 (0. 013), 0. 024 (0. 024), whether the long diameter was greater than 3 cm P0. 032, whether the long diameter was greater than 4 cm P0. 014) and the time when the CT value reached the peak value (P 0. 001) was compared between the two groups. The indexes that can be used to distinguish G1 / 2 from G3 are TapTVP and the peak time of enhanced CT value. The index of distinguishing G1 from G2 is 4MX 鈮，

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