Tsai Salina D, Kawamoto Satomi, Wolfgang Christopher L, Hruban Ralph H, Fishman Elliot K
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, 21231, USA,
Abdom Imaging. 2015 Jun;40(5):1121-30. doi: 10.1007/s00261-014-0322-7.
The purpose of the study is to evaluate the CT appearance and pattern of metastatic disease of patients with surgically resected well-differentiated duodenal neuroendocrine tumors who underwent pre-operative dual-phase CT.
Clinical and pathologic records and CT images of 28 patients (average age 58.0 years) following Whipple procedure were retrospectively reviewed. The size, morphology (polypoid, intraluminal mass or wall thickening, intramural mass), location, CT attenuation in the arterial and venous phases, and the presence of lymph node or liver metastases were recorded.
On CT, 19 patients (67.8%) had neuroendocrine tumors manifested as polypoid or intraluminal masses (38 lesions, multiple tumors in 3 patients), 4 patients (14.3%) had tumors manifested as wall thickening or intramural masses, and in 5 patients (17.9%), the primary tumor was not visualized. Lesions not seen at CT were less than 0.8 cm on pathologic diagnosis. The mean size of polypoid tumors on CT was 1.2 cm (range 0.3-3.8 cm); 24 tumors were 1.0 cm or smaller, and 14 tumors were larger than 1.0 cm. Most lesions were hypervascular in the arterial phase (19/23 patients) with an increase in tumor enhancement in the venous phase in 14 patients (60.9%), decrease in enhancement in 7 patients (30.4%), and no change in enhancement in 2 patients (8.7%). Thirteen patients (46.4%) had metastatic disease from carcinoid tumor, most commonly regional enhancing lymphadenopathy.
Duodenal carcinoid tumors commonly appear as an enhancing mass in either the arterial or venous phases. If a primary tumor is not seen in the duodenum, adjacent enhancing lymphadenopathy can be a clue to the presence of a duodenal carcinoid tumor.
本研究旨在评估接受术前双期CT检查并经手术切除的高分化十二指肠神经内分泌肿瘤患者的CT表现及转移病灶模式。
回顾性分析28例（平均年龄58.0岁）接受Whipple手术患者的临床、病理记录及CT图像。记录肿瘤大小、形态（息肉样、腔内肿块或壁增厚、壁内肿块）、位置、动脉期和静脉期的CT衰减值，以及有无淋巴结或肝转移。
CT检查显示，19例（67.8%）患者的神经内分泌肿瘤表现为息肉样或腔内肿块（共38个病灶，3例为多发肿瘤），4例（14.3%）患者的肿瘤表现为壁增厚或壁内肿块，5例（17.9%）患者未显示出原发肿瘤。CT未显示的病灶经病理诊断直径小于0.8 cm。CT上息肉样肿瘤的平均大小为1.2 cm（范围0.3 - 3.8 cm）；24个肿瘤直径为1.0 cm或更小，14个肿瘤直径大于1.0 cm。大多数病灶在动脉期为高血供（19/23例患者），14例患者（60.9%）的肿瘤在静脉期强化增加，7例患者（30.4%）强化降低，2例患者（8.7%）强化无变化。13例患者（46.4%）存在类癌转移，最常见的是区域强化淋巴结肿大。
十二指肠类癌肿瘤在动脉期或静脉期通常表现为强化肿块。如果十二指肠内未发现原发肿瘤，相邻的强化淋巴结肿大可能提示十二指肠类癌肿瘤的存在。
