Jang Kyung Mi, Kim Seong Hyun, Lee Soon Jin, Choi Dongil
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2014 Mar;55(2):140-8. doi: 10.1177/0284185113494982. Epub 2013 Jul 29.
Parenchyma-preserving resection for the treatment of benign pancreatic neuroendocrine tumors (NETs) has been tried, and preoperative prediction of benign pancreatic NET is important. Recently, diffusion-weighted imaging (DWI) of abdomen magnetic resonance imaging (MRI) has been used to characterize benign and malignant tumors and DWI might be helpful in prediction of benign pancreatic NETs.
To evaluate the value of gadoxetic acid-enhanced MRI and DWI in predicting benign pancreatic NETs for determination of parenchyma-preserving resection.
Our ethics committee approved this study with a waiver of informed consent given its retrospective design. We searched radiology and pathology databases from November 2010 to July 2012 to identify patients who underwent surgery for pancreatic NETs (<4 cm). Twenty patients in the benign group and 14 patients in the non-benign group were included in this study. Two radiologists analyzed the morphologic features, signal intensity on MR images including DWI (b = 800), and dynamic enhancement pattern of the tumors with consensus. The tumor-to-parenchyma ratio and tumor apparent diffusion coefficients (ADCs) were quantitatively assessed.
The benign pancreatic NETs were more often round (7/20, 35%) or ovoid (13/20, 65%) in shape and less hypovascular on the arterial phase (3/20, 15%) than were the non-benign pancreatic NETs (1/14, 7.1% and 5/14, 35.8%; 7/14, 50% respectively; P < 0.05). Main pancreatic duct dilatation by tumors was demonstrated only in non-benign pancreatic NETs (4/14, 28.4%; P = 0.021). ADC values and ratios were significantly different between benign pancreatic NETs (mean, 1.48 × 10(-3 )mm(2)/sec, 1.11 ± 0.25, each) and non-benign pancreatic NETs (mean, 1.04 × 10(-3 )mm(2)/sec, 0.74 ± 0.13, each) (P < 0.01). Other qualitative and quantitative analyses between benign and non-benign pancreatic NETs were not significantly different (P > 0.05).
Abdominal MRI with DWI may be useful for differentiating benign pancreatic NETs from non-benign pancreatic NETs, which might be helpful for determination of parenchyma-preserving resection.
已尝试采用保留实质的切除术治疗良性胰腺神经内分泌肿瘤（NETs），术前预测良性胰腺NET很重要。近来，腹部磁共振成像（MRI）的扩散加权成像（DWI）已用于鉴别良恶性肿瘤，DWI可能有助于预测良性胰腺NETs。
评估钆塞酸增强MRI和DWI在预测良性胰腺NETs以确定保留实质切除术方面的价值。
鉴于本研究为回顾性设计，我们的伦理委员会批准了本研究并豁免了知情同意。我们检索了2010年11月至2012年7月的放射学和病理学数据库，以识别接受胰腺NETs（<4 cm）手术的患者。本研究纳入了20例良性组患者和14例非良性组患者。两名放射科医生共同分析肿瘤的形态学特征、包括DWI（b = 800）在内的MR图像上的信号强度以及动态增强模式。对肿瘤与实质的比率和肿瘤表观扩散系数（ADCs）进行定量评估。
良性胰腺NETs的形状更常为圆形（7/20，35%）或椭圆形（13/20，65%），动脉期血管减少的情况比非良性胰腺NETs少（3/20，15% 对比1/14，7.1%；5/14，35.8%对比7/14，50%；P < 0.05）。仅在非良性胰腺NETs中发现肿瘤导致主胰管扩张（4/14，28.4%；P = 0.021）。良性胰腺NETs（均值分别为1.48×10(-3) mm(2)/秒、1.11±0.25）与非良性胰腺NETs（均值分别为1.04×10(-3) mm(2)/秒、0.74±0.13）之间的ADC值和比率有显著差异（P < 0.01）。良性和非良性胰腺NETs之间的其他定性和定量分析无显著差异（P > 0.05）。
腹部MRI联合DWI可能有助于鉴别良性胰腺NETs与非良性胰腺NETs，这可能有助于确定保留实质的切除术。
