壁结节的影像学表现对鉴别胰腺导管内乳头状黏液瘤良恶性的价值

发布时间：2018-06-02 21:47

本文选题：胰腺肿瘤 + 导管内乳头状黏液瘤　；参考：《第二军医大学学报》2017年05期

【摘要】：目的探讨壁结节的影像学表现在鉴别胰腺导管内乳头状黏液瘤(IPMN)良恶性中的价值。方法回顾性分析2012年1月至2016年6月于长海医院诊治的112例IPMN患者的病理和影像学资料。患者术前均行CT和MRI检查,由2位主治医师观察病灶壁结节的影像学表现,比较并分析良、恶性IPMN的壁结节大小、位置、个数、边界和强化程度。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价壁结节大小、个数、边界在鉴别IPMN良恶性中的作用,并确定壁结节大小的最佳诊断界值和敏感度、特异度及准确度。结果纳入经手术病理证实且在影像学检查中明确观察到壁结节的IPMN患者61例,病理检查结果示良性36例、恶性25例;主胰管型15例、分支型为13例、混合型33例,良、恶性患者IPMN分型差异有统计学意义(P=0.01)。壁结节大小对判断IPMN良恶性有临床意义(P0.01),其鉴别良、恶性的最佳诊断界值为1.35 cm,AUC为74.7%,敏感度56.0%、特异度91.7%、准确度77.5%。良、恶性患者的壁结节个数(P=0.02)、边界(P0.01)差异均有统计学意义,其鉴别良、恶性的AUC分别为64.2%、72.1%。所有患者壁结节强化程度均为渐进性强化,良、恶性患者的强化程度差异无统计学意义。结论壁结节影像学表现对IPMN良恶性的鉴别具有敏感性,对术前评估和随访具有一定的临床价值。
[Abstract]:Objective to investigate the value of imaging findings of mural nodules in differentiating benign and malignant pancreatic intraductal papillary myxoma (IPMN). Methods the histopathological and imaging data of 112 IPMN patients treated in Changhai Hospital from January 2012 to June 2016 were retrospectively analyzed. Both CT and MRI were performed before operation. The imaging findings of the lesions were observed by two attending physicians, and the size, location, number, boundary and enhancement degree of benign and malignant IPMN were compared and analyzed. The area under the curve was calculated to evaluate the role of the size, number and boundary of the wall nodules in differentiating benign and malignant IPMN, and to determine the best diagnostic threshold and sensitivity, specificity and accuracy of the size of the wall nodules. Results among 61 cases of IPMN confirmed by operation and pathology, 36 cases were benign, 25 cases were malignant, 15 cases were main pancreatic duct type, 13 cases were branching type, 33 cases were mixed type. The difference of IPMN classification in malignant patients was statistically significant (P < 0.01). The size of the wall nodule has clinical significance for the diagnosis of benign and malignant IPMN. The best diagnostic threshold for differentiating benign and malignant is 1.35 cm ~ (-1) IPMN. The sensitivity is 56.0, the specificity is 91.7, and the accuracy is 77.5. There were significant differences in the number of mural nodule between benign and malignant patients (P < 0.02, P 0.01). The AUC of benign and malignant was 64.2 and 72.1, respectively. The enhancement degree of wall nodules in all patients was progressive, but there was no significant difference between benign and malignant patients. Conclusion the imaging findings of mural nodules are sensitive to the differential diagnosis of benign and malignant IPMN, and have certain clinical value for preoperative evaluation and follow-up.
【作者单位】：第二军医大学长海医院影像医学科;
【分类号】：R735.9

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