Procacci C, Carbognin G, Accordini S, Biasiutti C, Bicego E, Romano L, Guarise A, Minniti S, Pagnotta N, Falconi M
Department of Radiology, University of Verona Medical School, Policlinico G.B. Rossi, Italy.
Eur Radiol. 2001;11(7):1175-83. doi: 10.1007/s003300000714.
The aim of this study was to assess the ability of spiral CT to adequately characterize the nonfunctioning endocrine tumors (NFETs) of the pancreas, distinguishing this lesion from the other pancreatic tumors. The spiral CT examinations of 21 cases of histologically proven NFETs, along with those of 29 cases of other pancreatic tumors and tumor-like lesions, were retrospectively reviewed in a blinded fashion by two radiologists, in order to correctly classify the lesions, highlighting the typical signs reported in the literature. Discordant cases were further analyzed in the presence of a third radiologist. The final diagnosis was acquired by means of a majority or overall consensus. The histopathologic examination was considered the gold standard. The sensitivity, specificity, and positive and negative predictive values of CT were calculated. After the consensus evaluation, the correct diagnosis was reached in 72% of cases, with 10% of nonspecific diagnoses of solid pancreatic tumor and 18% of wrong diagnoses. The sensitivity and specificity of spiral CT in identifying NFETs were 66.6 and 82.7%, respectively. The positive and negative predictive values were 73.7 and 77.4%, respectively. In up to 70% of cases the NFET demonstrates a typical aspect of a mass hyperdense in the arterial contrastographic phase eventually associated with hyperdense hepatic metastases in more than half of the patients. This finding does allow the diagnosis of NFET but without certainty indeed, since other tumors can show a similar densitometric behavior and among them particularly the ductal adenocarcinoma. On the other hand, both the solid, hypovascularized NFETs, and the cystic form, cannot be differentiated from the other solid and cystic tumors of the pancreas.
本研究的目的是评估螺旋CT充分表征胰腺无功能内分泌肿瘤（NFETs）的能力，将该病变与其他胰腺肿瘤区分开来。两名放射科医生以盲法回顾性分析了21例经组织学证实的NFETs的螺旋CT检查结果，以及29例其他胰腺肿瘤和肿瘤样病变的检查结果，以便正确分类病变，突出文献中报道的典型征象。在有第三名放射科医生参与的情况下，对存在分歧的病例进行了进一步分析。最终诊断通过多数意见或总体共识得出。组织病理学检查被视为金标准。计算了CT的敏感性、特异性以及阳性和阴性预测值。经过共识评估，72%的病例得出了正确诊断，10%为胰腺实性肿瘤的非特异性诊断，18%为错误诊断。螺旋CT识别NFETs的敏感性和特异性分别为66.6%和82.7%。阳性和阴性预测值分别为73.7%和77.4%。在高达70%的病例中，NFET在动脉造影期表现为典型的高密度肿块，最终超过一半的患者伴有高密度肝转移。这一发现确实有助于NFET的诊断，但并不确定，因为其他肿瘤也可能表现出类似的密度测定行为，尤其是导管腺癌。另一方面，实性、血供少的NFETs以及囊性形式，均无法与胰腺的其他实性和囊性肿瘤区分开来。
