Ogawa Hiroshi, Itoh Shigeki, Ikeda Mitsuru, Suzuki Kojiro, Naganawa Shinji
Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
Radiology. 2008 Sep;248(3):876-86. doi: 10.1148/radiol.2482071578. Epub 2008 Jul 15.
To evaluate the capabilities of multisection computed tomography (CT) in determining the likelihood of invasiveness of intraductal papillary mucinous neoplasm (IPMN).
The institutional review board approved this research and waived informed consent from the patients. Two radiologists blinded to the pathologic assessment of malignancy or parenchymal invasion of IPMN retrospectively evaluated CT images of 61 consecutive surgically resected tumors (26 adenomas, 15 noninvasive carcinomas, and 20 invasive carcinomas) in patients who underwent multiphase contrast material-enhanced CT with 0.5- or 1-mm collimation. The findings were statistically analyzed by using univariate and multivariate analyses, with the optimal cutoff levels of each continuous parameter determined by generating receiver operating characteristic curves.
The following findings showed significant differences among the three groups: maximum diameter of the main pancreatic duct (MPD), size (length of major axis) of the largest mural nodule in the MPD or in any associated cystic lesion, abnormal attenuating area in the surrounding parenchyma, calcification in the lesion, protrusion of the MPD into the ampulla of Vater, and bile duct dilatation. An MPD diameter of 6 mm or larger, a mural nodule of 3 mm or larger, and an abnormal attenuating area were independently predictive of malignancy. A mural nodule of 6.3 mm or larger in the MPD and an abnormal attenuating area were independently predictive of parenchymal invasion. According to these criteria, the sensitivity, specificity, and accuracy for identifying malignancy were 83%, 81%, and 82% and for identifying parenchymal invasion were 90%, 88%, and 89%, respectively.
Multisection CT is useful for distinguishing among adenoma, noninvasive carcinoma, and invasive carcinoma in patients with IPMN.
评估多排螺旋计算机断层扫描（CT）在确定导管内乳头状黏液性肿瘤（IPMN）侵袭可能性方面的能力。
机构审查委员会批准了本研究，并免除了患者的知情同意。两名对IPMN的恶性病理评估或实质侵犯不知情的放射科医生，回顾性评估了61例接受多期对比剂增强CT（准直为0.5或1mm）的患者连续手术切除肿瘤的CT图像（26例腺瘤、15例非侵袭性癌和20例侵袭性癌）。通过单因素和多因素分析对结果进行统计学分析，通过生成受试者操作特征曲线确定每个连续参数的最佳截断水平。
以下表现在三组之间存在显著差异：主胰管（MPD）最大直径、MPD或任何相关囊性病变中最大壁结节的大小（长轴长度）、周围实质内的异常衰减区域、病变内的钙化、MPD向Vater壶腹的突出以及胆管扩张。MPD直径≥6mm、壁结节≥3mm和异常衰减区域是恶性肿瘤的独立预测因素。MPD壁结节≥6.3mm和异常衰减区域是实质侵犯的独立预测因素。根据这些标准，识别恶性肿瘤的敏感性、特异性和准确性分别为83%、81%和82%，识别实质侵犯的敏感性、特异性和准确性分别为90%、88%和89%。
多排CT有助于区分IPMN患者的腺瘤、非侵袭性癌和侵袭性癌。
